Fosmer, Jo-Anne ( IF>
NEW YORK STATE DEPARTMENT OF HEALTH -
Bureau of Vital Records BurialTransit Permit
Name First Middle Last Sex
Jo-Anne Fosmer Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/14/2022 77 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address 23 Seward Street Apt. 10,Saratoga Springs,New York 12866
pManner of Death El Natural Cause ❑Accident Homicide Suicide ElUndetermined ri Pending
W Circumstances Investigation
W Medical Certifier Name Title
0 George Knapp DO
Address
520 Maple Ave,Saratoga Springs,New York 12866
Death Certificate Filed City Of Saratoga Springs District Number Register Number
City,Town or Village 4501 675
Burial Date Cemetery,Crematory or Facility Name
11/16/2022 Pine View Crematory
Entombment Address
(Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
t- Hold Address
CO
0
O. Date Point of
(I) Transportation Shipment
p by Common
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
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 11/16/2022 Registrar of Vital Statistics Di1Ton Moran(ECectronicalTySigned)
(signature)
District Number 4501 Place City Of Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition I I I ll I 1 Z Place of Disposition
2 (ad Tess/
W
EIC
f� (section) (/Dumber) (grave number)
8 Name of Sexton or Person in Charg • P ep
(pi se print)
W Signature Title (P0/(1
DOH-1555(07/18)pi of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Re resenting the funeral home named on,l rial permit
Official Funeral Directors Reg. or License# ' .j