Chatterton, Georgianna Theresa Or)
NEW YORK STATE DEPARTMENTOFHEALTH � 37�`
Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Georgianna Theresa Chatterton Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/05/2022 90 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation
EMan nerof Death IJ Natural Cause Accident OHomicide ❑Suicide Undetermined ❑Pending
W Circumstances Investigation
WMedical Certifier Name Title
0 Courtney Diamond NP
Address
170 Warren St,Glens Falls,New York 12801
Death Certificate Filed Cky Of Glens Falls District Number Register Number
Cit ,Town or Village 5601 252
Burial Date Cemetery,Crematory or Facility Name
05/08/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
DDonatwn
RemovalgEl Date Place Removed
and/or and/or Held
NHold Address
0
a. Date Point of
0 Transportation Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
ElReinterment
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Horne 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F Remains are Shipped,If Otherthan Above
2 Address
IX
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 055/06/2022 Registrar of Vital Statistics gieganNols`n(Flctron:4ySiirsea)
(signature/
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 7 zorz Place of Disposition -P,,AC U i e,,J e,
et ,mq-,11-__
2 (address)
W
Nct (section/ (lot limber) (grebe number)
8 Name of Sexton or Person in Cha of P e es ' )4$41//0NI) `i$%1�
Z /_/,.ease print/
!IJ Signature �1J 1/ Title 4i9p�-dt7�t
DOH 1555(07/18)pi of 2
t
Public Health Law Sec. 4145(2b)
1 Receipt
1 Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#