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Kelly, Laura Ann
© it- /do NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Laura Ann Kelly Female Date of Death Age If Veteran of U.S.Armed Forces, 07/31/2022 56 Years War or Dates 1,,. Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital a Manner of Death ❑x Natural Cause ❑Accident ❑Homicide Duicide ❑Undetermined Pending ILI V Circumstances Investigation to Medical Certifier Name Title O Jeremy Di Bari MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed City Of Glens Falls District Number Register Number ,Town orVillle Ce 560 1 399 Burial Date Cemetery,Crematory or Facility Name Addre2022 Pine View Crematory Entombment Address Cremation Oueensbury Town,New York DDonation Removal Date Place Removed and/or and/or Held pN Hold Address O Transportation Date Point of by Common Shipment Carrier Destination Date Cemetery Address Disinterment 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 1.. Remains are Shipped,If Other than Above 2 Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/02/2022 Registrar of Vital Statistics Nogaa.Noktr('Efatrotaca!ly,Sitne4 (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: WDate of Disposition gi 2 j It Place of Disposition ?rug 2 (address) W fA Q (section) (lot number/ (grave number) 8 Name of Sexton or Person in Cha of Premises ditiz 4i� 411" J ease print) fW C r �q Try Signature Title DOH 1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home•named on burial permit Official Funeral Directors Reg. or License#