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Hollenbeck, Claudia Gene . [et% I 5 NEW YORKSTATE DEPARTMENT OF HEALTH 1 Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Claudia Gene Hollenbeck Female Date of Death Age If Veteran of US.Armed Forces, 11/03/2023 78 Years War or Dates F— Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death EI Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title C Kelly Maley PA 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 515 Burial Date Cemetery,Crematory or Facility Name MIMI 11/06/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York DDonation ZO❑Removal Date Place Removed and/or and/or Held F- Hold Address U) 0 O. Date Point of U) Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address EIReinterment 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 H 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 11/06/2023 Registrar of Vital Statistics Megan Noli'n(EtectronicalrySigned) (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: I— Z Date of Disposition il II I 7, Place of Disposition fzy L,�aJ «Mrq ji Rtom ILI 2 (address) W LC (section) g ,(lot num (grave number) gt., 1,._ ,,,,�it Name of Sexton or Person in Charge of Pre z lease print) W Signature Title ( MH1 '( DOH-1555(07/18)p i of 2 �`.764 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#