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Tucker, Shirley Jane . I- TfI NEW YORKSTATE DEPARTMENT OF HEALTH (r....0 '+- Burial - Transit Permit Bureau of Vital Records Name .First Middle Last Sex Shirley Jane Tucker Female Date of Death Age If Veteran of U.S.Armed Forces, 10/25/2023 93 Years War or Dates F Place of Death Hospital,Institution or Z City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare p Manner of Death El Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title 0 Brandii Baker NP Address 4573 State Route 40,Argyle Town,New York 12809 Death Certificate Filed Town Of Argyle District Number Register Number City,Town or Village 5750 49 Burial Date Cemetery,Crematory or Facility Name 10/30/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation cl EI Removal Date Place Removed and/or and/or Held ~ Hold Address CO 0 a Date Point of U)ElTransportation 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 H Remains are Shipped,If Other than Above a Address CC W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/30/2023 Registrar of Vital Statistics Shelley Mckernon(E(ectronica((ySigned) (signature) District Number 5750 Place Town Of Argyle I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z Date of Disposition Ili 1 IZs Place of Disposition r40EdrE J trsrmtri'rr w,— DJ 2 (address) W CC CC (section) (lot number) (grave number) 8 Name of Sexton or Person in Charge of P miles �'.1 L S,tt z lease print/ !U Signature Title / DOH-1555(07/18)p 1 of 2 f 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#