Trudsoe, Louise it 7
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Louise Trudsoe Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/27/2021 84 Years War or Dates
F— Place of Death Hospital,Institution or
WCity,Town or Village Johnsburg Town Street Address Elderwood at North Creek
p Manner of Death 0 Natural Cause D Accident 1=1 Homicide 11 Suicide ❑Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
CI James Hindson MD
Address
112 Ski Bowl Rd,Johnsburg Town,New York 12853
Death Certificate Filed District Number - Register Number
City,Town or Village North Creek 5655 43
Burial Date Cemetery,Crematory or Facility Name
10/28/2021 Pine View Crematory
ElEntombment Address
11 Cremation Queensbury Town,New York
ElDonation
ORemoval Date Place Removed
and/or and/or Held
N Hold Address
0
Date Point of
co 11 Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment 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
1. Remains are Shipped,If Other than Above
5 Address
Q
W
• Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/28/2021 Registrar of Vital Statistics 7Catf/enC Lorah7tEt'ctronica451 Signed)
(signature)
District Number 5655 Place North Creek, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 0-, -,2001 Place of Disposition ?Q t/1.6i e ik-eru. Nr,f
2 (address)
W
Q (section) y� (lot number) (grave number)
O Name of Sexton or Person in Ch e of Pre i / r�� �0�1�
please print)
Signature Jl Title t'S4 r
Q�
DOH-1555(07/18)p 1 of 2
• 1 c271
Public Health Law Sec. 4145(2b) �m
Receipt
Human remains of ` delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#