Nevins, Paula E -)NEW YORK STATE DEPARTMENT OF HEALTH L�Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Paula E.Nevins Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/18/2022 86 Years War or Dates
1— Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death I1NaturalCause Accident El Homicide OSuicide Undetermined ❑Pending
iW Circumstances Investigation
WMedical Certifier Name Title
Bo Li MD
Address
100 100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 532
Burial Date Cemetery,Crematory or Facility Name
'.' 10/20/2022 Pine View Crematory
Entombment Address
ECremation Queensbury Town,New York
Donation
60 Removal Date Place Removed
and/or and/or Held
~
N Hold Address
O
4. Date Point of
N)❑Transportation
by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
F— Remains are Shipped,If Other than Above
2 Address
CC
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/20/2022 Registrar of Vital Statistics !Megan Noun(E(ectronicafy Signed)
(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
IU Date of Disposition IC 1 Ii 1 ZL Place of Disposition -�� /�rc..—
/address)
W
CC (section) /iot number) (grave number)
SName of Sexton or Person in Charge Premises l' t1
Z (pi se print)
W Signature Title (VAllifrope
DOH-1555(07/18)p 1 of 2
a
•
•
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#