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Swain, Margaret Mary 1(:.....;...F..). il 9 Vo NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Margaret Mary Swain Female Date of Death Age If Veteran of U.S.Armed Forces, 10/21/2023 86 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 1264 West Mountain Road Apt 312,Queensbury Town,New York 12804 p Manner of Death ❑X Natural Cause Accident 0 Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title 0 Lauren Dinsmore PA Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 159 Burial Date Cemetery,Crematory or Facility Name 10/24/2023 Pine View Crematory Entombment_ Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 O. Date Point of U)❑Transportation p by Common Shipment Carrier Destination ODisinterment 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 i— Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/24/2023 Registrar of Vital Statistics Caroline?fi&fegarde Barber(ECectronicallySigned) (signature) District Number 5657 Place Town Of Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition /O 1 Zb 1 13 Place of Disposition -I zw6✓x f,4J Gl�,+l��� 2 (address) W N (section) (lot` number (grave number) I r V S Name of Sexton or Person in Charge of Premises, lease print) W Signature Title � �t DOH-1555(07/18)p 1 of 2 w1.7 6 04 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# I 1 '