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Williams, Catherine Irene toF /1- 'di S- NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Catherine Irene Williams Female Date of Death Age If Veteran of U.S.Armed Forces, 04/11/2023 61 Years War or Dates i,,. Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 55 Hampton Court,Queensbury Town, New York 12804 IIU 0 Manner of Death Natural Cause Accident ❑Homicide OSuicide Undetermined El Pending ILI Circumstances Investigation W Medical Certifier Name Title CI Agee!Gillani 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 58 Burial Date Cemetery,Crematory or Facility Name 04/14/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York []Donation 0 O Removal Date Place Removed and/or and/or Held H Hold Address N 0 O. Date Point of (f) Transportation p by Common Shipment Carrier Destination ODisinterment 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 W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/13/2023 Registrar of Vital Statistics Caroline Jfi&degarde cBar6er(ECectronica1Ty 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: ZZ Date of Disposition LI bet 73 Place of Disposition �.,,1(_ r-= ILI 2 (address) W NCC (section) (lot number) (grave number) S Name of Sexton or Person in Charge of Premises G trfiZ /pl1L._ a print/ W Signature 11) Title (I?bm 4V( DOH-1555(07/18)p 1 of 2 1'168 4 Public Health Law Sec. 4145(2b) Receipt Human remains of = delivered on , 20 L. Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#