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Packard, Grace D
)11- NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex i Grace D.Packard Female Date of Death Age If Veteran of U.S.Armed Forces, 0• 2/04/2022 74 Years War or Dates P• lace of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital 111 ch Ill Manner of Death ©Natural Cause ❑Accident 0 Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title O Gwendolyn Morris-Dickinson PA t Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 79 ❑Burial Date Cemetery,Crematory or Facility Name 02/07/2022 Pine View Crematory ❑Entombment Address n ej Cremation Queensbury Town,New York e ❑Donation Z Removal Date Place Removed and/or and/or Held H Hold Address CO 0 0. Date Point of to �Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address :z` 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 yr Name of Funeral Firm Making Disposition or to Whom F- Remains are Shipped,If Other than Above g Address CC a Permission is hereby granted to dispose of the human remains described above as indicated. • Date Issued 02/07/2022 Registrar of Vital Statistics Megan Notin(ECectronica1 ySigned) (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: I- Z Date of Disposition .,- 7-0-4— Till Z— Place of Disposition � V t,w Gre.m4�oCy W 2 (address) W Ncc (section) (lot number) (grave number) gName of Sexton or P n in Charge of Premises -37e,r1%i i/ S V 1 r<,s z (pleasprint) 111 s,: Signature �, �,iC ,m/.. Title tart y-lot DOH-1555(07/18)p 1 of 2 1 5614 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#