Baird, Lesile Ann o tt 1 cp
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Leslie Ann Baird Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/19/2022 60 Years War or Dates
F Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
0 Manner of Death ❑x Natural Cause Accident Ei Homicide ESuicide Undetermined ri Pending
W Circumstances Investigation
W Medical Certifier Name Title
G Howard Silverberg MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
Town or Village 5601 483
Burial Date Cemetery,Crematory or Facility Name
09/21/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
DDonation
60 RemovalDate Place Removed
p and/or and/or Held
QN Hold Address
a Date Point of
Cl)❑Transportation Shipment
25 by Common
Carrier Destination
O
Disinterment
Date Cemetery Address
El
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
2 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/21/2022 Registrar of Vital Statistics JHegan Noun(ECectronicallySigned)
(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:
I—
Z Date of Disposition 9 I477,_ Place of Disposition -}-,,,k�/ 7,�f-�
W (address/
W
NCC (section) (lot number) (grave number)
S Name of Sexton or Person in Charge o ises /�t°r
lease print)
W Signature Title motif
DOH-1555(07/18)p 1 of 2
03_6 256
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#