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Ingraham, Dorothy Marion L # gz NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Dorothy Marion Ingraham Female Date of Death Age If Veteran of US.Armed Forces, 10/06/2023 85 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Moreau Town Street Address 564 Selfridge Road,Moreau Town, New York 12831 W Manner of Death Undetermined Pending W Natural Cause Accident Homicide Suicide g Circumstances Investigation W Medical Certifier Name Title 0 Aimee Mcmaster NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Moreau District Number Register Number City,Town or Village 4562 54 Burial Date Cemetery,Crematory or Facility Name 10/11/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held H N Hold Address 0 n. Date Point of U)❑Transportation p by Common Shipment Carrier Destination 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 Remains are Shipped,If Other than Above 2 Address Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/10/2023 Registrar of Vital Statistics Brenda 7futter(ECectronicaltySigned) (signature) District Number 4562 Place Town Of Moreau I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition 10 I t,'y Place of Disposition r r•JEt/ ,Ev CQ,�r►trgYOQ�,�..� (address) W N (section) 7 (lot number/ (grave number) 8 Name of Sexton or Person in Charge of Pre r t)L Z tease print/ W Signature (2 Title r4Z� DOH-1555(07/18)p 1 of 2 a ; �t"� Public Health Law Sec. 4145(2b) �� 7 3 k 6 Receipt Human remains of delivered on , 20� t-- Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#