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Protor, Myrtle M. NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Myrtle M.Proctor Female Date of Death Age If Veteran of U.S.Armed Forces, 11/29/2021 83 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death ©Natural Cause Accident ❑Homicide ❑Suicide El Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title Paul Bachman MD Address 9 Carey Rd,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 560 ❑Burial Date Cemetery,Crematory or Facility Name 12/03/2021 Pine View Crematory ❑Entombment Address u Cremation Queensbury Town,New York ❑Donation Z Date Place Removed O ❑Removal and/or and/or Held Hold Address 0 n- Date Point of co Li Transportation by Common Shipment Carrier Destination Disinterment 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 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/02/2021 Registrar of Vital Statistics cRpdertAn1rew Curtis(ECectronical1y 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: W Date of Disposition )p I� Place of Disposition go 2 (address) W (section) iQ(lot number) (grave number) caName of Sexton or Person in Charge f remises /, Z (plea print) LU Signature Title l+ .r0Wi DOH-1555(07/18)p i 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#