Masters, Melaine A . id 8
F
NEWYORKSTATE DEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Melanie A.Masters Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/22/2022 66 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
E Mannerof Death E3 Natural Cause ❑Accident Homicide Suicide Undetermined Pending
W
0 Circumstances Investigation
G
Medical Certifier Name Title
Timothy Murphy Coroner
Address
52 Havitand Avenue,Glens Falls,New York 12801
DeaAth Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 387
Burial Date Cemetery,Crematory or Facility Name
07/26/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Don ation
❑Removal Date Place Removed
and/or and/or Held
pN Hold Address
0
t1. Date Point of
W❑Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
OReinterment
Permit Issued to Registration Number
Name of Funeral Home finder Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
1.— 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 07/25/2022 Registrar of Vital Statistics .lawdza Nan(!hartnrcaf Srgnsd)
(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:
W Date of Disposition 742-?7, .y Place of Disposition F1 V;,�t✓ c.i rhr Y
a (address)
W
ti)
CC (section)
-- (lot number) (grate.number)
Name of Sexton or Person in Charge of Premises 1 -emery s'gj 1 tc.5
W / / (please print)
Signature `%%�s% Title Gfe,'i41or
DOH-1555(07/t8)pi of 2 v
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#