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Converse, Cynthia Marie ,Q17.1 tit- Li-TS NEW YORK STATE DEPARTMENT OF HEALTH ) Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Cynthia Marie Converse Female Date of Death Age If Veteran of U.S.Armed Forces, 06/05/2023 61 Years War or Dates i_ Place of Death I-lpspital,Institution or Z City,Town or Village Warrensburg Town Street Address 1823 Harrington Hill Road,Warrensburg Town,New York 12845 p Manner of Death ❑^ Natural Cause Accident Homicide Suicide ❑Undetermined Pending Circumstances Investigation W Medical Certifier Name Title G Erin Lasher NP Address 43 New Scotland Avenue MC7,Albany, New York 12203 Death Certificate Filed Town Of Warrensburg District Number Register Number City,Town or Village 5660 Burial 44, Date Cemetery,Crematory or Facility Name i. :;, 06/07/2023 Pine View Crematory EntombmeiMdress • ` ©Cremation $ ieensbury Town,New York r Donation 0❑Removal Date Place Removed and/or and/or Held F Hold 'Address U) 0 O. ate Point of 0❑Transportation ,;;_ Shipment Q by Common Carrier Destination ODisinterment 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 a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/07/2023 Registrar of Vital Statistics Pamela M Lroye(ECectronicalry Signed) (signature) District Number 5660 Place Town Of Warrensburg I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition jv i g I /3 Place of Disposition ',au, Z,L. tii 2 (address) W NCC (section) (lot number) (grave number) gName of Sexton or Person in Charge of P emises ' A.iilL, .atIft Z (ptiase print) /p ZV W ilivZ Signature Title " � DOH-1555(07/t8)p 1 of 2 e 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#