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Wallace, Isbelle Mae UL , . r .g..i?i NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Isabelle Mae Wallace Female Date of Death Age If Veteran of U.S.Armed Forces, 10/29/2023 83 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death EI Natural Cause Accident 0 Homicide nSuicide nUndetermined ElPending W Circumstances Investigation W Medical Certifier Name Title 0 Mathew Varughese DO 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 507 Burial Date Cemetery,Crematory or Facility Name 11/02/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation ZO Removal Date Place Removed and/or and/or Held F Hold Address N 0 O. Date Point of to Transportation Shipment Q by Common 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 F Remains are Shipped,If Other than Above 2 Address CC W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/01/2023 Registrar of Vital Statistics Megan.NoCin(ECectronicalTy 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: I— Date of Disposition it 3i Z3 Place of Disposition f It4tn, .�) ({ tf1Trai 2 (address) W Nir (section) A (lot number) (grave number) SName of Sexton or Person in Cha of Premises /If Z (p/ se print) In Signature2 Title lY'rF�►"Imo ......"...— DOH-1555(07/18)pi of 2 1 21 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#