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Charlson, Gail Ellen tt 617NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Name First Middle Last Sex Gail Ellen Charison Female Date of Death Age If Veteran of U.S.Armed Forces, 08/08/2023 70 Years War or Dates 1— Place of Death Hospital,Institution or pZ City,Town or Village Knox Town Street Address 104 Nature Center Way, Knox Town, New York 12186 Manner of Death ❑Natural Cause Accident Homicide Suicide Undetermined Pending W V Circumstances Investigation WD Medical Certifier Name Title Paul Marra Coroner Address 112 State Street,Albany,New York 12207 Death Certificate Filed Town Of Knox District Number Register Number City,Town or Village 0156 23-09 Burial Date Cemetery,Crematory or Facility Name '® 08/10/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation OZ Removal Date Place Removed F, and/or and/or Held N Hold Address 0 d Date Point of Cl) Transportation p by Common Shipment Carrier Destination ElDisinterment 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 1— Remains are Shipped,If Other than Above 2 Address CC W D. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/10/2023 Registrar of Vital Statistics Traci Schanz(ECectronica((y Signed) (signature) District Number 0156 Place Town Of Knox I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition oil(13 Place of Disposition 'i„(L, (L4.____,IJU 2 (address W Cl) CC (section) (lot number) (grave number) SName of Sexton or Person in Cha f Premises A If Z lease print/ W Signature Title �(2tnx} DOH-1555(07/18)p 1 of 2 I Public Health Law Sec. 4145(2b) 1 1 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# j ;