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Wilsey, Audrey B
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Audrey B Wilsey Female Date of Death Age If Veteran of U.S.Armed Forces, 04/04/2023 92 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Warrensburg Town Street Address 1 Cloverleaf Drive,Warrensburg Town, New York 12885 p Manner of Death El Natural Cause Accident Homicide Suicide Undetermined Pending LU 0 Circumstances Investigation 0 Medical Certifier Name Title Mary Stein NP Address 9 Carey Road,Queensbury Town, New York 12804 Death Certificate Filed Town Of Warrensburg District Number Register Number City,Town or Village 5660 6 Burial Date Cemetery,Crematory or Facility Name 04/06/2023 Pine View Crematory Entombment— Address ©Cremation Queensbury Town,New York IIIDonation 0 Removal Date Place Removed and/or and/or Held N Hold Address 0 a Date Point of (I) Transportation C-) by Common Shipment Carrier Destination Disinterment Date Cemetery Address nReinterment 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 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/06/2023 Registrar of Vital Statistics Tame&a MGCoyd ECectronicatrySigned) (signature) District Number 5660 Place Town Of Warrensburg I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition y 7 ZoZ3 Place of Disposition 'jO Crej1e•�,c (address) W CC (section) (lot number) (grave number) O Name of Sexton or Person in Charge of Premisesf� �lyl0✓+/ L/Gbc' Z (please print) Signature Title alreSF DOH-1555(o7/t8)p i of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of J delivered on , 20 Pine 'iew Cemetery Representing the funeral home named on burial.. ermit Official Funeral Directors Reg.or License#