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Poete, Dorothy Hyde tt 5 NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Dorothy Hyde Poette Female Date of Death Age If Veteran of U.S.Armed Forces, 11/04/2021 80 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Queensbury Town Street Address 36 Leo Street,Queensbury Town,New York 12804 p Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide EiUndetermined Pending IL Circumstances Investigation W Medical Certifier Name Title 0 Aged Gillani MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 216 0 Burial Date Cemetery,Crematory or Facility Name 11/08/2021 Pine View Crematory ❑Entombment Address X❑Cremation - Queensbury Town,New York ❑Donation 6 Removal Date Place Removed and/or and/or Held F Hold Address 0 O. Date Point of ❑ Cl) Transportation by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/08/2021 Registrar of Vital Statistics Caroline J/i[egardeBarber(ECectronicallySigned) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ~ Date of Disposition If I it(Zi Place of Disposition f�� �ne*Dr„_., (address) W Cl) CC (section) (lot numbe (grave number) GName of Sexton or Person in Charge of Premi es Z / 'please print) W Signature Title t DOH-1555(07/18)p 1 of 2 ui k i a4` Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License 4-