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Nolan, Rosemary Donna NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Rosemary Donna Nolan Female Date of Death Age If Veteran of U.S.Armed Forces, 11/27/2021 82 Years War or Dates ▪ Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 32 Fort Amherst Road,Queensbury Town,New York 12804 ▪ Manner of Death Undetermined Pending W El Natural Cause Accident Homicide Ei Suicide 11 Circumstances Investigation W Medical Certifier Name Title David Cunningham MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 227 ❑Burial Date Cemetery,Crematory or Facility Name 11/30/2021 Pine View Crematory 0 Entombment Address ▪ Cremation Queensbury Town,New York ElDonation to Removal Date Place Removed and/or and/or Held - Hold Address 0 L1- Date Point of U) Li 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 Remains are Shipped,If Other than Above 2 Address cr W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/30/2021 Registrar of Vital Statistics Caroline 9 gganl Bather(i1ectronicallj,Signed) (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: IF- �1 Jj Z Date of Disposition / /-Zi'Zi Place of Disposition Tide tr.GJ eremet7t7 Ni 2 (address) W N CC (section) (lot number) (grave number) gName of Sexton or Person in Charge Premise I<A 1,:tiL' 1,3 Z (please print) IW Signature Title ©ee,r4L—I0G T— 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# f_�