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Colvin, Mary Ellen NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Mary Ellen Colvin Female Date of Death Age If Veteran of U.S.Armed Forces, 05/26/2023 77 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Hudson Falls Village Street Address 87 Main Street, Hudson Falls Village, New York 12839 'p Manner of Death Natural Cause Accident Homicide Suicide Undetermined ri Pending Circumstances Investigation W Medical Certifier Name Title C Kenneth France MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Village Of Hudson Falls District Number Register Number City,Town or Village 5726 13 Burial Date Cemetery,Crematory or Facility Name MUM 05/31/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York ElDonation g Removal Date Place Removed and/or and/or Held ~ Hold Address 0 d. Date Point of t/) Transportation p by Common Shipment Carrier Destination O 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 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/31/2023 Registrar of Vital Statistics Cynthia ABardin(E(ectronica((ySigned) (signature) District Number 5726 Place Village Of Hudson Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition r I 3l (? Place of Disposition -(� ,v_ l 2 (address) W CC CC (section) ) (lot number) (grave number) Name of Sexton or Person in Charge of Premises �Q — tt i7 llJ (please print) W Signature / j Title �e � DOH-1555(07/18)p 1 of 2 » Y t� sta (� 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#