Winfrey, Nadja Helcott !OF . 3g y
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Nadja Helcott Winfrey Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/05/2022 63 Years War or Dates
H. Place of Death Hospital,Institution or
WCity,Town or Village Granville Town Street Address Slate Valley Center for Rehabilitation and Nursing
p Manner of Death El Natural Cause Accident 0 Homicide OSuicide Undetermined Pending
IW
V Circumstances Investigation
G Medical Certifier Name Title
Joshua Starteri NP
Address
10421 State Route 40,Granville Town,New York 12832
Death Certificate Filed Town Of Granville District Number Register Number
City,Town or Village 5756 30
RBurial Date Cemetery,Crematory or Facility Name
05/09/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
DDonation
0 Removal Date Place Removed
H and/or and/or Held
N Hold Address
0
O. Date Point of
U)❑Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
IIReinterment 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
i— Remains are Shipped,If Other than Above
2 Address
Q
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/09/2022 Registrar of Vital Statistics jenny Linda M Martelie(ECectronicalTy Signed)
(signature)
District Number 5756 Place Town Of Granville
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IH �
W Date of Disposition S/10 la Placeof Disposition ` l(+a_ �C,,j�a,_,-
2 (address)
W
U)
GQ (section) 4,,ii..._,lot namberl\� (grave number)
Name of Sexton or Person in Charge of Premises �J�h�
z lease print)
/�
W Signature �-�1 Title C 44°114 TOK
DOH-1555(07/18)p 1 of 2
�1 11,.. 5 cr _...
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on t , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License#