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Healy, Thomas Joseph NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Thomas Joseph Healy Male Date of Death Age If Veteran of US.Armed Forces, 11/03/2023 83 Years War or Dates 1957-1960 1— Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 16 North Court,Queensbury Town,New York 12804 LU p Manner of Death Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation WMedical Certifier Name Title a Adrianna Earl Other Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 168 Burial Date Cemetery,Crematory or Facility Name IMMIN 11/07/2023 Pine View Cremaotry ,Entombment Address ©Cremation Queensbury Town,New York Donation ZO Removal Date Place Removed and/or and/or Held N Hold Address 0 0. 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 F 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 11/07/2023 Registrar of Vital Statistics Caroline x((egardeBar6er(E(ectronicaCCySigned) (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 1( 13 Place of Disposition 471Cv�Y �,, cn1qidR� 2 (address) W CC f/) (section) //7 (lot number) (grave number) SName of Sexton or Person in Charge Premises ` ^ it please print) Z W Signature Title ��M,q DOH-1555(07/18)pi of 2 Public Heal w Sec. 4145(28) r 1 7 6 4 6 Receipt Human remains of r ( ; i ,i delivered on , 20 `,) Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# r(.1 1` st