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Sain, Eileen Veronica ""@ 41 6 Z 1 NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial _ Transit Permit Name First Middle Last Sex Eileen Veronica Sain "Si,, Female Date of Death Age If Veteran of U.S.Armed Fortes, 08/01/2023 71 Years War or Dates i_ Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 9 Wayne Court,Queensbury Town,New York 12804 0 Manner of Death Natural Cause Accident 0 Homicide El Suicide nUndetermined riPending W Circumstances Investigation W Medical Certifier Name Title 0 Robert Love MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 121 Burial Date Cemetery,Crematory or Facility Name 08/03/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York DDonation ZO❑Removal Date Place Removed and/or and/or Held N Hold Address CO 0 ID. Date Point of (/)El Transportation Shipment p by Common Carrier Destination Disinterment 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 L— Remains are Shipped,If Other than Above M Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/03/2023 Registrar of Vital Statistics Caroline?fil1egarieBar6er(El ctronicaQySigned) (signature) District Number 5657 Place Town Of Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition 9—y1-Zp7 3 Place of Disposition pi Alt e (4 e,.) 0** /1 ay 1':5 2 (address) W Cl)CC (section) (lot numbed (grave number) 0 Name of Sexton or Person in Charge of PremisesA��U^t 6 (,)cod ' (please print) Z f W Signature ` Title ` { DOH-1555(07/18)p 1 of 2 I `,'= i 7 1 7 II' Public Health Law Sec. 4145(2b) 1 IReceipt 1 1 Human remains of /' ' delivered on , 20 il a Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# `