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Raymond, Brenda Lois .... 4 ol (L-- NEW YORK STATE DEPARTMENT OF HEALTH i Burial - Transit Per Bureau of Vital Records t Name First Middle Last Sex Brenda Lois Raymond Female Date of Death Age If Veteran of U.S.Armed Forces, 08/10/2022 75 Years War or Dates WZ Place of Death Hospital,Institution or City,Town or Village Glens Falls Street Address 26 Thomberry Drive,Glens Falls,New York 12801 p Manner of Death El Natural Cause Accident 0 Homicide 0Suicide Undetermined Pending LIJ C.) Circumstances Investigation WD Medical Certifier Name Title Aimee Mcmaster Nurse Practitioner,Acute Care 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 414 Burial Date Cemetery,Crematory or Facility Name 08/12/2022 Pine View Crematory Entombment Address Cremation Queensbury Town,New York Donation Removal Date Place Removed H and/or and/or Held N Hold Address 0 a. Date Point of Cl) Transportation C1 by Common Shipment Carrier Destination ElDisinterment 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 E.- Remains are Shipped,If Other than Above 5 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/11/2022 Registrar of Vital Statistics %tegan.Nolin(ECectronica1TySigned) (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 i3Zt- pZe Place of Disposition e vVe LA' 4{f Cr-ej 2 (addresskJ W N CC (section) lot number) (grave number) GName of Sexton or Person in Cha e of Premi �Yil'w,+d l� C'/ Z (please print) W Signature i / Title ©ir�a',I- i DOH-1555(07/18)p 1 of 2 .00 w' ,6 1 Public Health Law Sec. 4145(2b) Receipt Human remains of I delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#