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Pelletier, Marie RZ°Z NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Marie Pelletier Female Date of Death Age If Veteran of U.S.Armed Forces, 02/28/2023 57 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Johnsburg Town Street Address 3 Circle Avenue,Johnsburg Town,New York 12853 p Manner of Death El Natural Cause Accident Homicide Suicide Undetermined ElPending UCircumstances Investigation aILI Medical Certifier Name Title Lynn Keil PA Address 1340 State Route 9,Lake George Town,New York 12845 Death Certificate Filed Town Of Johnsburg District Number Register Number City,Town or Village 5655 7 Burial Date Cemetery,Crematory or Facility Name 03/03/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York DDonation o❑Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 O. Date Point of (/)Dransportation p by Common Shipment Carrier Destination Disinterment 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 1— Remains are Shipped,If Other than Above Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/02/2023 Registrar of Vital Statistics jean 9K Comstock(E(ectronica((y Signed) (signature) District Number 5655 Place Town Of Johnsburg I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 1 W Date of Disposition )3 13 Place of Disposition '; L �f1 2 (address) W N CC (section) (tot numbed.- (grave number) g Name of Sexton or Person in Charge o ._ �t f Premises 1 Pt - w�.11 Z ��/ease print/ jllJ Signature X,.„. r Title Il7�l�� j DOH-1555(07/18)pi of 2 e 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#