Peck, Betty L i
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NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Betty L.Peck Female
lk Date of Death Age If Veteran of U.S.Armed Forces,
41 04/17/2022 76 Years War or Dates
'; Place of Death
Hospital,Institution or
LU
City,Town or Village Thurman Town Street Address 68 Hall Mountain Road,Thurman Town,New York 12810
p Manner of Death ❑X Natural Cause Accident [ ]Homicide Duicide []Undetermined Pending
111
Circumstances Investigation
Medical Certifier Name Title
Ryan Donnelly DO
Address
y 9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Thurman District Number Register Number
City,Town or Village 5659 7
Burial Date Cemetery,Crematory or Facility Name
04/20/2022 Pine View Crematory
Entombment Address
MCremation Queensbury Town,New York
Donation
Z Date Place Removed
t ❑Removal
and/or and/or Held
H Hold Address
fp
Cl)❑Transportation Date Point of
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
,
Date Cemetery Address
❑Reinterment
Permit Issued to
Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
„' Name of Funeral Firm Making Disposition or to Whom
F`- Remains are Shipped,If Other than Above
Address
CC
O.
, , Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/20/2022 Registrar of Vital Statistics Cynthia X xyde(ECectronicallySigned)
(signature)
District Number 5659 Place Town Of Thurman
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition Li bo 177 Place of Disposition "FfIL A___./
2 (address)
W
CO (section) - (lot number (grave number)
6 Name of Sexton or Person in Charge of emises r•I L ^ t
Z (please print)
W Signature Title (PfAlrfN
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