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Wickham, Paula M Lot NEW YORK STATE DEPARTMENT OF HEALTH 15 Bureau of Vital Records �' Burial - Transit Permit Name First Middle Last Sex Paula M.Wickham Female Date of Death Age If Veteran of U.S.Armed Forces, 05/10/2023 94 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Chester Town Warren Street Address 294 Knapp Hill Road,Chester Town Warren,New York 12817 p Manner of Death 0 Natural Cause Accident ❑Homicide 0Suicide nUndetermined nPending WI—I Circumstances 1-11nvestigation W Medical Certifier Name Title Michael Miles MD Address 9 Carey Road,Queensbury Town, New York 12804 Death Certificate Filed Town Of Chester District Number Register Number City,Town or Village 5652 7 Burial Date Cemetery,Crematory or Facility Name 05/15/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation ❑Removal Date Place Removed and/or and/or Held Hold Address O O. Date Point of (I)ElTransportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address OReinterment 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 � Remains are Shipped,If Other than Above g Address C W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/12/2023 Registrar of Vital Statistics Nlincfy Conway(ECectronica(Cy Signed) (signature) District Number 5652 Place Town Of Chester I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition j i L S I Zj Place of Disposition ,,,t W 2 (address) W N CC (section) //J (lot-number) (grave number) O Name of Sexton or Person in Charge o Premises Z ase print/ IJJ wipe Signature Title fee-in DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) Receipt I Human remains of delivered on , 20 Pine View Cemetery Representing the'funeral home named on burial permit Official Funeral Directors Reg.or License#