Baker, Betty Lou 421
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Betty Lou Baker Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/07/2022 83 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 xi Natural Cause 0 Accident Homicide Suicide Ej Undetermined Pending
Circumstances Investigation
WMedical Certifier Name Title
O Gwendolyn Morris-Dickinson PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 17
EjBurial Date Cemetery,Crematory or Facility Name
01/10/2022 Pine View Crematorium
ElEntombment Address
Cremation Queensbury Town,New York
❑Donation
Removal Date Place Removed
and/or and/or Held
pHold Address
U) ❑Transportation Date Point of
5 by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141
Address
9 Pine St,Chestertown,New York 12817
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
2 Address
CC
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/10/2022 Registrar of Vital Statistics Megan"loan(ECectr'onicaaj 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: ar.-• Date of Disposition I/ivIZZ. Place of Disposition 474_
IW
Cl) (section) / (lot number) C (grave number)
Name of Sexton or Person in Charge of Pr ises /+ "r
Z irlease print/
fW Signature Title � '
DOH-1555(07/18)p 1 of 2
1 ._ .740, .....
Public Health Law Sec. 4145(2b)
1
I Receipt
1
I
Human remains of '' delivered on ` , 20-- ,;1_..
r , ,
Pine View Cemetery Representing the funeral home named urial permit
Official Funeral Directors Reg.or License# ` ` "