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Dempsey, Deborah Ann
(tZIFYL135 NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Deborah Ann Dempsey Female Date of Death Age If Veteran of U.S.Armed Forces, 05/21/2023 63 Years War or Dates 1— Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital `p Manner of Death El Natural Cause IllAccident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title Q William Cleaver MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 258 Burial Date Cemetery,Crematory or Facility Name 05/22/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation goRemoval Date Place Removed' H and/or and/or Held N Hold Address O EL Date Point of to ElTransportation p by Common Shipment Carrier Destination oDisinterment Date Cemetery Address EIReinterment 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 Q W O Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/22/2023 Registrar of Vital Statistics Megan%Win(ECectronica(CySigned) (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: Z W Date of Disposition S(2S1/3 Place of Disposition (address) CC N (section) / (lot number) c (grave number) 8 Name of Sexton or Person in Charge of Premises L M 4 Z (4ease print) W Signature Title lm4�2 DOH-1555(o7/18)p 1 of 2 q c Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial peinit Official Funeral Directors Reg.or License#