Loading...
Tokos, Irene G F vs-c- NEW YORKSTATE DEPARTMENT OF HEALTH �,,Lt� Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Irene G.Tokos Female Date of Death Age If Veteran of U.S.Armed Forces, 09/10/2023 98 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital jp Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title G Julian Marynczak PA 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 429 Burial Date Cemetery,Crematory or Facility Name 09/12/2023 Pine View Crematorium Entombment Address • ©Cremation Queensbury Town,New York Donation ❑Removal Date Place Removed and/or and/or Held H Hold Address CO 0 d Date Point of U) Transportation Q by Common Shipment Carrier Destination 111 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 i.. Remains are Shipped,If Other than Above 2 Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/12/2023 Registrar of Vital Statistics Megan Alban(ECectronicafty Signed) (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: Date of Disposition f iT 113 Place of Disposition " 4 2 (address) W CC (section) /16 (lot number) (grave number) gName of Sexton or Person in Charge of Premises n Z (p se print/ W Signature Title l �TA �1Q DOH-1555(07/18)p 1 of 2 ;l" T 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# _ '`{