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Sylvester, Helen R # , ,--, . 1...(....,.......F.). NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Helen R.Sylvester Female Date of Death Age If Veteran of U.S.Armed Forces, 09/18/2023 101 Years War or Dates 1,_ Place of Death Hospital,Institution or WCity,Town or Village Minerva Town Street Address 471 Morse Memorial Highway,Minerva Town,New York 12857 W• Manner of Death IEINatural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title O Kate Sauer-Jones PA Address 9 Carey Road,Queensbury Town, New York 12804 Death Certificate Filed Town Of Minerva District Number Register Number City,Town or Village 1557 5 Burial Date Cemetery,Crematory or Facility Name 09/20/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation OZ❑Removal Date Place Removed and/or and/or Held F- Hold Address N 0 a Date Point of 0)oTransportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address 1 Reinterment 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 F. Remains are Shipped,If Other than Above 5 Address IX W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/20/2023 Registrar of Vital Statistics `Theresa Fish('Electronically Signed) (signature) District Number 1557 Place Town Of Minerva I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I- /Z Date of Disposition 9 1 h 113 Place of Disposition FFLV—, 2 (address) W 0 (section) �f (lotn�ei/ � (grave number) 0 Name of Sexton or Person in Charge o ' s (((h — A Z (p 'ase print) W Signature Title r �I��2 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 4` Receipt Human remains of delivered on , 20 _ Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#