Grrant, Carol A L /1,07,s
,, F
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
?? Carol A.Grant Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/23/2022 78 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
`p Manner of Death aNSfu'ral Cause Accident ❑Homicide Suicide Undetermined Pending
Circumstances Investigation
Q Medical Certifier Name Title
Kasandra Frasier PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 652
Burial Date Cemetery,Crematory or Facility Name
12/27/2022 Pine View Crematory
—
Entombment Address
.h-IlUCremation Queensbury Town,New York
-ODonation
Z Date Place Removed
op Removal
H and/or and/or Held
N Hold Address
0
a Date Point of
U) Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
, ElE
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
.. Remains are Shipped,If Other than Above
M Address
LIC
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/27/2022 Registrar of Vital Statistics Megan Nolin(E(ectronica((ySigned)
(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:
I-
Z Date of Disposition /2 Z�3-2v zz_Place of Disposition e.„J p v.e.,� ('r- , 40 C-�W
2 (address)
W
et N (section) (lot number) (grave number)
gName of Sexton or Person in Ch ge of Pre es IciAeitito,s b Over/
Z (please print)
11J Signature 4" Title er.)- .'
DOH-1555(07/18)p 1 of 2
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#