Walkins, Arleen Y NEW YORK STATE DEPARTMENT OF HEALTH fOF
, Burial - Transit Permit
Bureau of Vital Records
Name First • Middle Last Sex
Arleen Y.Watkins Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/14/2022 85 Years War or Dates
H Place of Death Hospital,Institution or
WCity,Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing
p Manner of Death ❑X NaturalCause nAccident ❑Homicide Suicide Undetermined ❑Pending
✓ Circumstances Investigation
W Medical Certifier Name • Title
Roslyn Socolof MD
Address
42 Gurney Ln,Queensbury Town,New York 12804
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 87
Burial Date Cemetery,Crematory or Facility Name
05/17/2022 Pine View Crematory
Entombment Address
▪Cremation Queensbury Town,New York
▪Donation
0❑Removal Date Place Removed
and/or and/or Held
F Hold Address
N
0
a. Date Point of
(I) Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
❑Reinterment
Date Cemetery Address
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
1— Remains are Shipped,If Other than Above
a Address
Q
Hi
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/16/2022 Registrar of Vital Statistics Caroline f1fi(fegarde Barber(ECectronicalTySigned)
(signature)
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition El I$i 21 Place of Disposition F� 1 iC-i* ---
tU
2 (address)
W
CC (section) (lot number) {. (grave number)
gName of Sexton or Person in Charge of Premises i,i l`l
z
/ple�e print/ /��
W Signature ��"- Title /f� ��'2
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
1
1
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#