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Morin, Vivian Anne Z gitNEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Vivian Anne Morin Female Date of Death Age If Veteran of U.S.Armed Forces, 03/22/2023 76 Years War or Dates F. Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing Ip Manner of Death J Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation 0 Medical Certifier Name Title Roslyn Socolof MD Address 42 Gurney Ln,Queensbury Town,New York 12804 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 39 Burial Date Cemetery,Crematory or Facility Name 03/24/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York DDonation 0 Removal Date Place Removed and/or and/or Held _ �- Hold Address irn IL Date Point of Cl)❑Transportation S by Common Shipment Carrier Destination Disinterment 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 1— Remains are Shipped,If Other than Above 2 Address CC O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/24/2023 Registrar of Vital Statistics Caroline Jfi&degardeBar6er(ECectronica(CySigned) (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 tU Date of Disposition 3 Z,;-21jPlace of Disposition doe (/:ea) Creirfrdar 2 (address) W CO (section) (lot number) (grave number) SName of Sexton or Person in Charge of Premises ) Al/1a _ Z (please print) W Signature Title aee.r2dmr DOH-1555(07/18)p t 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#