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Baker, Pauline Mae
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Pauline Mae Baker Female Date of Death Age If Veteran of U.S.Armed Forces, 02/05/2022 84 Years War or Dates F- Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined 0 Pending W Circumstances Investigation W Medical Certifier Name Title O Scott Biasetti MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 94 ©Burial Date Cemetery,Crematory or Facility Name 02/19/2022 Pine View Cemetery ❑Entombment Address ❑Cremation Queensbury Town,New York ❑Donation 0 El Removal Date Place Removed - and/or and/or Held H- Hold Address N 1 O O. Date Point of CO ❑Transportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address El 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 2 Address Q IW O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/10/2022 Registrar of Vital Statistics Megan Nolin(Electronically 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: L ` Date of Disposition Q iq . as Place of Disposition a I Q 1 C�rQ t�1) c 151D_ ' 1 44' W (address) Q N �►nekcVt, \\q "l C EC (sedgy (lot number),�,, (grave number) SName of Sexto or Person in Charge of Premises (�' In'� C© �—dee—e-r Z (please print) W Signature �• e Title1-� JC' 1 n �'R DOH-1555(07/18)pi of 2 #asuaatl io lax sio3aai1Q Ieiaund FPUJO , i lnulad[eunq uo pauieu auuoq jr..mun;alp Suuuasaidag km w D main auk' I ' f OZ ` • uo paianilap -- I Jo suteuia1 uetunH r ldiaaag 1 1 006 TO tr (gZ)svIt 'aaS tAgl tglgaH atlgnd l BAITER, VIDINIEDIXICE (17:f9 Lot No: 7 c Address 63 Main St.. West ulens Falls, N.Y. Sects NO. Owner Mrs. Pauline Baker Plot Unadilla. Ext. Date 4/9/73 1 Superficial ft. @ $2.00 per sq. tit_ Location %onded on the North by Vacant, East by Path., South by Saunders, West by Vacant Corner Posts Remarks Deed No. (and changes) 1259 Payment Record fill 4/9/73 Form No. 01 Record of Interments Donovan E. Baker ( h/9/73) 1 5 2' ov,��i r1tC o7 1C'I a �� Q-S 3 ,31I+ft,r) Cot. f t,r 7 4 { 8 s fi A v / BAKER NAME Pauline Baker Age: 84 Lot Owner: Pauline Baker Lot# Unadilla Ext. 7C Grave# 2 Case: Concrete Died: 2 .5.2 2 Interred: 2. 1 9.2 2 Funeral Home: Baker FH Cemetery: Pine View