Chandler, Christa H }I. /
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Permit
Name First Middle
Christa H.Chandler Last Sex
Date of Death Age If Veteran of U.S.Armed Forces, Female
06/26/2022 78 Years War or Dates
H Place of Death
Z City,Town or Village Hospital,Institution or
WQueensbu Town Street Address Willowbrook Road 34
p Manner of Death Apt.304,Queensbury Town,New York 12804
Natural Cause
V ❑Accident Homicide Suicide Undetermined
Pending
CMedical Certifier Name Circumstances Investigation
Anthony Petracca Title
MD
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed Town Of Queensbury District Number
City,Town or Village 5657 Register Number
Burial Date 105
Cemetery,Crematory or Facility Name
_Jtntombment 07/01/2022 Pine View Crematory
Address
Cremation Queensbury Town,New York
Donation
csRemoval Date Place Removed
F.- and/or I and/or Held
N Hold Address
0
0. Date Point of
N❑Transportation
C by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to
Name of Funeral Home Maynard D Baker Funeral Home Registration Number
Address 01130
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F— Remains are Shipped,If Other than Above
a Address
CC
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/28/2022 Registrar of Vital Statistics Carofine5fifilegarde Barber(ElectronicalfySigned)
(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—
W Date of Disposition ZpZZ Place of Disposition :JP (��erJ �'r/,„k���
(ad Tess/
IW
CA
Q (section) (lot number) (grave number)
gName of Sexton or Person in Charge of P mise �`✓/�,J pp
1Z ` (please print/
Signature Title O -trk:
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DOH-1555(o7/18)p 1 of 2
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Public Health Law Sec. 4145(2b)
Receipt
1
Human remains of delivered on , 20
1
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#