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Michon, Shirley Marie k" -F,) NEW YORK STATE DEPARTMENT OF HEALTH ) Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Shirley Marie Michon Female Date of Death Age If Veteran of U.S.Armed Forces, 07/01/2023 85 Years War or Dates 1_ Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death El Natural Cause Accident 0 Homicide OSuicide El Undetermined ri Pending W U Circumstances Investigation G Medical Certifier Name Title Marvin Davidowitz 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 321 Burial Date Cemetery,Crematory or Facility Name 07/05/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed F;, and/or and/or Held N Hold Address 0 O. Date Point of t/)❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment 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 F- 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 07/03/2023 Registrar of Vital Statistics Megan Wolin(ElectronicaCCySigned) (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 Z Date of Disposition --)I S I Z3 Place of Disposition ��lj 2 (address) W N CC (section) (lot number) , (grave number) gName of Sexton or Person in Charge of Premises It Z p/eprint/ W Signature /., TitletrzEd4 if Tog DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of - ' f delivered on , 20 IPine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#