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Flewelling, Lottie Marie NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Lathe Made FlewelNng Female Date of Death Age If Veteran of U.S.Armed Forces, 06/10/2022 95 Years War or Dates f Place of Death Hospital.Institution or Z City,Town or Village Queensbury Town Street Address 41 Cottage HiN Road,Queensbury Town,New York 12804 0 Manner of Death ENatural CauseAccident 0Hornicide Suicide nUndetermined ❑Pending W Circumstances Investigation WMedical Certifier Name Title 0 Aimee Mc master Nurse Practitioner,Acute Care Address 9 Carey Road,Queenebury Town,New York 12804 Death Certificate Filed Town aQueensbun► District Number Register Number C' ,Town orVillare 5657 98 X Burial Date Cemetery,Crematory or Facility Name Addre2022 Pie View Cemetery Entombment Address Cremation Clueensbury Town,New York Donation SORemoval Date Place Removed and/or and/or Held p Hold Address 0 0• Date Point of t/1 ]Transportation b by Common Shipment Carrier Destination Disinterment Date Cemetery Address 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 p. Remains are Shipped,If Other than Above 2 Address CC U1 ti Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/13/2022 Registrar of Vital Statistics Came!nw.7GhagankOpder( OF 4's (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: I— Z Date of Disposition l as Place of Disposition ,Q\ 5)u6 VeQ ()1 it.. 1�t\y N )28� ui (address) `J N CC1.�r ,'IL /"xT 3'7A (Q ,ct I (lot number) (grave number) 8 Name of Sexton or Person in Charge of Premises ► ��de e;*- �_ (please print) W �� �� ( P _ e Title t.c�� r (-14 1�11. cr) ' Signature T 4 DOH 1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 012925 Receipt Human remains of delivered on _, 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# FLEWELLING NAME Lottie Marie Flewelling Age: 95 Lot Owner: Allen & Lottie Flewelling Lot# Unadilla Ext. 37A Grave# 2 Case: Concrete Died: 6. 1 0.2 2 Interred: 6. 17.22 Funeral Home: Baker FH Cemetery: Pine View FLEWELLING �1 Lot NNa-. 37 I Address !il Cottage Hill Rd., Lilens Falls, N.Y. f Section No. Owner Allen P. Flewe11im & Lottie M. Flewelling Plot Unadilla Ext. Date.. 8/2/73 200 Superficial ft. @ $2.00 per sq. ft. Location Bounded on the North by Vacant, East iyPath, South by Vacant, West b7 Road Corner Posts Remarks Deed No. (and changes) 1277 Payment Record Paid in full 8/2/73 Form No. 01 Record of Interments 1 Allen D. Flewelling 12/10/01 15 2 V ie ('RRSZIe- V\Ci,.�111(18. l c'- 1`L c�of 16 I Lewis Flewelline (h/21/71,) 3 1 7 4 I 8 I 15,q-T - -- I©, • -3\* ' i.c=-, I X Vic) 1 'Roll-8