Pidgeon, Majorie Leona r 44, iti 55 1
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
, Marjorie Leona Pidgeon
;• Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/09/2022 85 Years War or Dates
1., Place of Death Hospital,Institution or
WCity,Town or Village Day Town Street Address 36 Rice Road,Day Town,New York 12835
p Manner of Death a Natural Cause Accident El Homicide nSuicide FlUndetermined riPending
W Circumstances Investigation
UIMedical Certifier Name Title
Lia Braico NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Day District Number Register Number
City,Town or Village 4554
Burial Date Cemetery,Crematory or Facility Name
07/14/2022 Pine View Crematory
—Entombment Address
Cremation Queensbury Town,New York
Donation
fl Removal Date Place Removed
and/or and/or Held
' Hold Address
N
0
I- Date Point of
Ua El Transportation
p 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
F Remains are Shipped,If Other than Above
% Address
III
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/14/2022 Registrar of Vital Statistics Caro(Vai(rancourt(E(ectronica((ySigned)
(signature)
District Number 4554 Place Town Of Day
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z a
au
of Disposition jSiZZ Place of Disposition 4._
i,,,,.�
2 (address)
Ili
N
CC (section) (lot numbe (grave number)
Ga Name of Sexton or Person in Char f Premises 4 P. Ll
41
Z (pplease print) '
ILI 1,RPM HP/
Signature Title
DOH-1555(o7/t8)p 1 of 2
1 c
i Public Health Law Sec. 4145(2b)
1
1
IReceipt
t
iHuman remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# ' '