Morse, Shirley Baker r !' 415
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Shirley Baker Morse Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/04/2022 94 Years War or Dates
�.: Place of Death Hospital,Institution or
Z City,Town or Village Horicon Town Street Address 6832 State 8 Route,Horicon Town,New York 12815
ILI
p Manner of Death El Natural Cause ❑Accident El Homicide OSuicide Undetermined ElPending
W Circumstances Investigation
W Medical Certifier Name Title
K] Lynn Keil PA
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Horicon District Number Register Number
City,Town or Village 5654 6
Burial Date Cemetery,Crematory or Facility Name
12/07/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
Z Date Place Removed
0❑Removal and/or Held
F- and/or
N Hold Address
0
d Date Point of
U) Transportation
p by Common Shipment
Carrier Destination
Disinterment El
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
Remains are Shipped,If Other than Above
Address
CC
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/06/2022 Registrar of Vital Statistics ?(fista G Wood'(Efectronica1Ty Signed)
(signature)
District Number 5654 Place Town Of Horicon
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
�J�
Z Date of Disposition IZ I Iv I iL Place of Disposition 7j'r-_
2 (address)
W
CC CC (section) jlot number/ v, (grave number)
gName of Sexton or Person in Charge of remises /A c
Z lease print/
UI Signature Title (k441 0C
DOH-1555(07/18)p t of 2
I Public Health Law Sec. 4145(2b)
Receipt
IHuman remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#