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Heroux, Eva Loretta NEW YORK STATE DEPARTMENT OF HEALTH 1 Bureau of Vital Records �.,. Burial - Transit Pe it Name First Middle Last Sex Eva Loretta Heroux Female Date of Death Age If Veteran of U.S.Armed Forces, 02/17/2023 102 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address Glens Falls Center for Rehabilitation and Nursing O Manner of Death ❑X Natural Cause ❑Accident Homicide ESuicide Undetermined riPending 11.1 Circumstances Investigation WMedical Certifier Name Title O Elizabeth Bessette NP Address 152 Sherman Ave,Queensbury Town,New York 12801 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 28 Burial Date I Cemetery,Crematory or Facility Name 02/21/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held t- Hold Address 0 Q. Date Point of U)ETransportation p by Common Shipment Carrier Destination ElDisinterment 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 a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/21/2023 Registrar of Vital Statistics Caroline 2fi((egarc a Barber(E(ectronicaCCy Signed) (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 Date of Disposition 2 i Z3 1Z) Place of Disposition mot',...k�/�, (address) W CC CC (section) (lot number/ (grave number) SName of Sexton or Person in Charge of Premis s t ' "' -- Z ( ase print) W Signature � Title Cl2FymHVI DOH-1555(o7/18)p t of 2 . x 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#