Morales, Andrea Marie #13
- orl)
N EW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Andrea Marie Morales Female
Date of Death Age If Veteran of U.S.Armed Forces,
02/05/2023 41 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 ❑X Natural Cause ❑Accident ❑Homicide Suicide Undetermined ri Pending
Circumstances Investigation
WMedical Certifier Name Title
G Shahid Ahmed MD
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 69
Burial Date Cemetery,Crematory or Facility Name
02/08/2023 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
a. Date Point of
N❑Transportation
Q by Common Shipment
Carrier Destination
Date Cemetery Address
Disinterment
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
�.. Remains are Shipped,If Other than Above
5 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/07/2023 Registrar of Vital Statistics Megan.No(in(ECectronicaffy Signed)
(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:
Date of Disposition Z-0—jvl3 Place of Disposition Rav V e! ) 6-44.1 4,,fq
2 (address
W
CC (section/ (lot numbe (grave number)
I`
g Name of Sexton or Person in Cha e of Pre ' s f b^t b ijte d
(please print)
W Signature Title Crr-174,
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
1
Human remains or delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#