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Ford, Debra L ._ it,„:::40 # sl NEW YORK STATE DEPARTMENT OF HEALTHBurial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Debra L.Ford Female Date of Death Age If Veteran of U.S.Armed Forces, 10/20/2023 65 Years War or Dates n or Hospital,Institution Place of Death P W Glens Falls Hospital P City,Town or Village Glens Falls Street Address p Manner of Death El Natural Cause Accident El Homicide OSuicide nUndetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title CI Asim Chaudry MD 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 492 Burial Date Cemetery,Crematory or Facility Name 10/24/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation 6 Removal Date Place Removed and/or and/or Held H Hold Address N 0 n. Date Point of U)❑Transportation Q by Common Shipment Carrier Destination ODisinterment Date Cemetery Address n Date Cemetery Address I11 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 1— Remains are Shipped,If Other than Above N Address Q W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/23/2023 - Registrar of Vital Statistics Megan Wolin(E(ectronica1Cy 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: Z W Date of Disposition /p IA 113 Place of Disposition ,FT:q.-vy4.v CR-ic selrtti dk ,+...,_ 2 (address) W U) (section) (lot_number) (grave number) 8 Name of Sexton or Person in Charge of P mises r eP Sj/V1 7<h. ....,‘ zi W t) Signature6, Title r 64/Di DOH-1555(07/18)p 1 of 2 .?400 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 ./ dr Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# ,/