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Pike, Alice May
# 77c NEW YORK STATE DEPARTMENT OF HEALTH � Burial - Transit Permit Bureau of Vital Records � Name First Middle Last Sex Alice May Pike Female Date of Death Age If Veteran of U.S.Armed Forces, 03/06/2023 74 Years War or Dates F. Place of Death Hospital,Institution or W City,Town or Village Queensbury Town Street Address 18 Farr E Lane 115,Queensbury Town, New York 12804 1pManner of Death Z Natural Cause Accident IIHomicide Suicide Undetermined Pending Circumstances Investigation 11J Medical Certifier Name Title CI Darci Gaiotti-Grubbs MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 34 Burial Date Cemetery,Crematory or Facility Name 03/08/2023 Pine View Crematory _Entombment Address ©Cremation Queensbury Town,New York Donation 0 ElRemoval Date Place Removed and/or and/or Held F- Hold Address N 0 a Date Point of U) Transportation p by Common Shipment Carrier Destination ODisinterment 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 a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/08/2023 Registrar of Vital Statistics Caroline 2fiCdegarie Barber(ECectronicallySigned) (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: ZZ , Date of Disposition 3I'1 I Z3 Place of Disposition IL tu 2 (address) W CCCC (section) ja (lot number) (grave number) O• Name of Sexton or Person in Charge of Premises /A''t p 4 it please print) Z �i 0ng7Oa, W Signature i Title 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#