Corbett, Tammy Ann l F it. 13b
NEW YORKSTATE DEPARTMENT LTH
Bureau of Vital Records - ‘ek.„.-- Burial - Transit Permit
Name First Middle Last Sex
Tammy Ann Corbett Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/10/2022 58 Years War or Dates
i_ Place of Death Hospital,Institution or
W City,Town or Village Queensbury Town Street Address 389 Dixon Road,Queensbury Town,New York 12804
W Manner of Death a Natural Cause ❑Accident Homicide Ei
Suicide ❑Undetermined ❑Pending
Circumstances Investigation
0
Medical Certifier Name Title
G 3` John Stoutenburg MD
Address
100 Park St,Glens Falls,New York 12801
DeaEth Certificate Filed Town Of Queensbury District Number Register Number
Ciitv,Town or Village 5657 131 ,
Burial Date Cemetery,Crematory or Facility Name
0911
9/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
DDonation
goRemovalDate Place Removed
and/or and/or Held
NHold Address
0
O. Date Point of
(A Transportation Shipment
a by Common
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
Remains are Shipped,If Other than Above
5 Address
IE
W
Q. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/13/2022 Registrar of Vital Statistics Caroline xFlJar413anfergfearo>ru'alryS&h14 J
(signature)
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
W Date of Disposition y 1Ll 1 17 Place of Disposition ,
a (address)
W
� (section) ��A►Fot n�an��'I t (gravenumber)
8 Name of Sexton or Person in Charge of Premises
(p ase print)
{�- ^tr
IU Signaturez
Title ` � �1
DOH 1555(o7/18)p 1 of 2
1 6 2
r
fi:£Yll. � ,-7
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#