Stewart, Cathy Lee NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Cathy Lee Stewart Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/18/2022 70 Years War or Dates
Place of Death Hospital,Institution or
'Z City,Town or Village Hartford Town Street Address 3939 State Route 196,Hartford Town,New York 12827
p Manner of Death ENatural Cause ❑Accident Homicide ❑Suicide ElUndetermined ❑Pending
W Circumstances Investigation
WMedical Certifier Name Title
G John puaresima MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town of Hartford District Number Register Number
C• ,Town or Ville 5759 5
X Burial Date Cemetery,Crematory or Facility Namery
05/24/2022 Pine View Cemete
Entombment Address
Cremation Queensbury Town,New York
Donation
1Removal Date Place Removed
and/or and/or Held
NHold Address
Transportationri
Date Point of
by Common Shipment
Carrier Destination
Date Cemetery Address
❑Disinterment
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
E— Remains are Shipped,If Other than Above
a Address
CC
Permission Is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/24/2022 Registrar of Vital Statistics 1Jlnttsiaie#rys(EYacYmttrca45,
(signature)
District Number 5759 Place Town Of Hartford
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
Date
W Date of Disposition S••,'y•c2 Place of Disposition )i ()LtQ We 2_ r� Ladd ass,..si„..,! tr l�/
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W '1'Y13I !<- i ,6 /
Cl) sedbonl ! (lot number) (grave number)
°C ��c1 can
8 Name of Sexton or Person in Charge of Prem. s ,F,nili'c
(please print)
W Signature /� Title �c f / I.hilGICfi
DOH-1555(07/18)p 1 of 2
1-
Public Health Law Sec. 4145(2b)
U 1 2 9 1 q
Receipt
1 Human remains of delivered on , , 20
1
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-------A n w egmetery -- Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
STEWART
NAME Cathy Stewart Age: 70
Lot Owner: Cathy Stewart
Lot# Mohican 35 B Grave# 1
Case: Concrete
Died: 5. 1 8.2 2 Interred5.2 4.2 2
Funeral Home: Baker FH
Cemetery: Pine View Cemetery
STEWART
LLot No. 35
Address 11 Bluebird Terrace, Fort Edward, N.Y. 12822 Section No. B
Owner Cathy L. Stewart Plot Mohican
Date 8/23/90
Approx. 33 Superficial ft. @
Location Bounded on North by Vacant, South by Sawn, East by Vacant, West by Vacant.
Corner Posts
Remarks
Deed No. (and changes) 2308
Payment Record Paid in Full 8/23/90
kecord of Interments
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Form No. 01