McIntyre, Carol Ann ,„,_
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NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Carol Ann McIntyre Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/28/2022 75 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address Park Street,Glens Falls,New York 12801
p Manner of Death Natural Cause Accident El Homicide ESuicide FlUndetermined ElPending
W Circumstances Investigation
WMedical Certifier Name Title
0 Tanya Finch NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 295
Burial Date Cemetery,Crematory or Facility Name
R06/01/2022 Pine View Crematory
Entombment Address
aCremation Queensbury Town,New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held
-- Hold Address
N
0
Date Point of
Cl)❑Transportation Shipment
Q by Common
Carrier Destination
Disinterment Date Cemetery Address
OReinterment 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
1.- Remains are Shipped,If Other than Above
2 Address
Q
W
CI-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/01/2022 Registrar of Vital Statistics Megan Notin(ECectronicalry Signed)
(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:
Z ;� �
W Date of Disposition (�/3�"f;2 Place of Disposition ��,. L L�'�
M lad ress
W
O(section) d
rpVot number) 5,00,
4.0
0(grave number)
G Name of Sexton or Person in Charge of Premises /p/ elpr��int/ n
W ow limit<
Signature t `` Title
DOH-1555(07/18)p 1 of 2
rt i
Public Health Law Sec. 4145(2b)
Receipt
IHuman remains of '� - � delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License#