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Goodale, Karen Ann INCS 714- • II NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Karen Ann Goodale Female Date of Death Age If Veteran of U.S.Armed Forces, 05/23/2023 64 Years War or Dates F.. Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address 94 Lawrence Street,Glens Falls, New York 12801 Manner of Death El Natural Cause Accident ri Homicide ESuicide Undetermined Pending VCircumstances Investigation al Medical Certifier Name Title CI Laurie Dennison NP Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 265 Burial Date Cemetery,Crematory or Facility Name 05/23/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 6❑Removal Date Place Removed H and/or and/or Held N Hold Address 0 O. Date Point of N)❑Transportation ES 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 g Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/23/2023 Registrar of Vital Statistics Megan No('n(ECectronicaCCySigned) (signature) District Number 5601 Place City Of Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition s/Z(,123 Place of Disposition 7, (address) W CC (section) /l (lotnumber/_ (grave number) SName of Sexton or Person in Charge of Premises /�� Z , ( lease print) W Signature Title ticiM'q I DOH-1555(07/18)p 1 of 2 i q a, l R 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#