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Paulin, Marie May NEW YORK STATE DEPARTMENT OF HEALTH '�%' Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Marie May Paulin Female Date of Death Age If Veteran of US.Armed Forces, 10/01/2023 86 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Johnsburg Town Street Address Elderwood at North Creek 1p Manner of Death ❑X Natural Cause Accident EI Homicide Suicide .Undetermined Pending Circumstances Investigation W Medical Certifier Name Title James Hindson MD Address 112 Ski Bowl Rd,Johnsburg Town,New York 12853 Death Certificate Filed Town Of Johnsburg District Number Register Number City,Town or Village 5655 42 Burial Date Cemetery,Crematory or Facility Name 10/05/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation ❑Removal Date Place Removed and/or and/or Held ~ Hold Address N O O. Date Point of d)❑Transportation p by Common Shipment Carrier Destination 11 Disinterment Date Cemetery Address Date Cemetery Address Reinterment 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 Remains are Shipped,If Other than Above 2 Address Q iW C' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/05/2023 Registrar of Vital Statistics Jean M Comstock(Efectronica((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: 2 Date of Disposition hp-e jpz3 Place of Disposition (P; e Cle-771t� 2 (address/ W CC (section) (l number/ (grave number) gName of Sexton or Person in Charge of Premi A�ivlO.�� o� Z c (please print) (�C W Signature sr"/ Title �� DOH-1555(07/18)p 1 of 2 4 j 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# (