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Murray, Crystal L NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records `' Name First Middle ' Last Sex Crystal L.Murray Female Date of Death Age If Veteran of U.S.Armed Forces, 11/08/2021 60 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined El Pending ILJ Circumstances Investigation W0 Medical Certifier Name Title 0 Shahid Ahmed MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 498 aBurial Date Cemetery,Crematory or Facility Name 11/10/2021 Pine View Crematory ❑Entombment Address lCremation Queensbury Town,New York ❑Donation Z Removal Date Place Removed and/or and/or Held ~ Hold Address UA 0 n- Date Point of N ❑Transportation Q by Common Shipment Carrier Destination ElDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg, New York 12885 Name of Funeral Firm Making Disposition or to Whom F Remains are Shipped,If Other than Above 2 Address EC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/09/2021 Registrar of Vital Statistics WgbertAndrew Curtis(ECectronicalty Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F— Z Date of Disposition 11117 1 11 Place of Disposition V Or6 UJ 2 (address/ W NCC (section) /f�/otnumber) (grave number) GName of Sexton or Person in Charge of Premises �n4 L— S`""t 7 g (p/ease riot/ /�,,,c LU Title d "�1�2 Signature ' DOH-1555(07/18)p 1 of 2 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#