Genier, Katherine Joanne 'i )1 AS3
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NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Katherine Joann Genier Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/24/2022 52 Years War or Dates
F Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 543 Aviation Road 110,Queensbury Town,New York 12804
IJJ Manner of Death II Natural Cause Accident Homicide Suicide ❑Undetermined Pending
V Circumstances Investigation
W Medical Certifier Name Title
CI Connie Goedert Coroner
Address
1400 St Route 9,Lake George Town,New York 12845
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 159
Burial Date Cemetery,Crematory or Facility Name
10/28/2022 Pine View Crematory
Entombment Address
nCremation Queensbury Town,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
F- Hold Address
N
0
a Date Point of
CO EITransportation
p by Common Shipment
Carrier Destination
III
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
N Address
2
IW
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/28/2022 Registrar of Vital Statistics Carolinexkkgard Bar6er(ElectronicallySigned/
(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:
Z �7
W Date of Disposition /®._�,Zc7L Place of Disposition " �,$)� �/,'e�) L s—��'►1�ti-=�e-r
2 (address)
W
NCC (section) no/number) (grave number)
gName of Sexton or Person in Cha of Premise 1 /(1yrntri,i J WOO()
Z (please print)
W Signature 1� y3' a Title L'rfreL �
DOH-1555(o7/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt c
1
1 Human remains of delivered on , 20 -
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#