Sander, Helen ii f' • ,�-, -? If fry
NEWYORKSTATEDEPARTMENTOFHEALTH i Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Helen Sander Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/14/2022 98 Years War or Dates
F. Place of Death Hospital,Institution or
11.1
Z City,Town or Village Queensbury Town Street Address 344 Glen Lake Road,Queensbury Town, New York 12804
p Manner of Death El Natural Cause Accident El Homicide ESuicide Undetermined Pending
WEI
0 Circumstances Investigation
WD Medical Certifier Name Title
Mary Stein NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 21
Burial Date Cemetery,Crematory or Facility Name
11/17/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
N Hold Address
0
a Date Point of
N❑Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
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
a Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/16/2022 Registrar of Vital Statistics cPatrtciaR,9Ic7(inneySchuster(E(ectronicalTySigned)
(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:
Z74...„
Date of Disposition II ii 1 t Place of Disposition �/, �(
2 (aderess)
W
N
S (section)
/1 (tut number) (grave number)
Name of Sexton or Person in Cha of Premises LL n L-- f'_" It
z (pl se print
11J Signature Title ! -11
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of ' delivered on , 20
e.
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
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