Harding, Majorie Adele NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Marjorie Adele Harding Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/22/2022 100 Years War or Dates
F.. Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
• Manner of Death ❑X Natural Cause El Accident ❑ Homicide Suicide LiUndetermined 1=1 Pending
W Circumstances Investigation
C.) Medical Certifier Name Title
CI Marcille Labban MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 57
❑Burial Date Cemetery,Crematory or Facility Name
01/25/2022 Pine View Crematory
❑Entombment Address
iCremation Queensbury Town, New York
❑Donation
g El Removal Date Place Removed
and/or and/or Held
f- Hold Address
0
a. Date Point of
CO Li Transportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
❑Disinterment
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
H Remains are Shipped,If Other than Above
Address
C
W
0. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/24/2022 Registrar of Vital Statistics MeganNaCin(J ctronicaiT 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:
Z Date of Disposition i7S12Z Place of Disposition � � � (7„.4111r"...,
W
2 (addr ss)
W
CC
N (section) (lot number) (g rave number)
/
O Name of Sexton or Person in Cha a of Premises h f•sa
tt Z (pie e print)
W 6364114 foe
Signature / Title
DOH-1555(07/18)p t of 2
I55F4
Public Health Law Sec. 4145(2b)
Receipt
Human remains of • ; 4 delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# _ -