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Anselmo, Linda R NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permi Bureau of Vital Records Name First Middle Last Sex Linda R.Anselmo Female Date of Death Age If Veteran of U.S.Armed Forces, 09/09/2023 79 Years War or Dates �,. Place of Death Hospital,Institution or WCity,Town or Village Johnsburg Town Street Address Elderwood at North Creek pManner of Death Natural Cause Accident Homicide ESuicide Undetermined Pending Circumstances Investigation G Medical Certifier Name Title Leah Terry NP Address 4573 State Route 40,Argyle Town,New York 12809 Death Certificate Filed Town Of Johnsburg District Number Register Number City,Town or Village 5655 32 Burial Date Cemetery,Crematory or Facility Name 09/12/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation o❑Removal Date Place Removed and/or and/or Held N Hold Address 0 O. Date Point of U):Transportation CI Common Shipment Carrier Destination Disinterment 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 Remains are Shipped,If Other than Above a Address CC O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/11/2023 Registrar of Vital Statistics lean JK Comstock(ECectronica((y Signed) (signature) District Number 5655 Place Town Of Johnsburg I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition 113)13 Place of Disposition t��` IJJ (address) W N (section) (l number) .(grave number) S Name of Sexton or Person in Charge of P 'ses r. f ff Z (pleaseiirtbt) UJ Signature Title VVV /` �' �� DOH-1555(07/18)pi of 2 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#