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Nelson, Emma E _ _ Li. 937 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Emma E.Nelson Female Date of Death Age If Veteran of U.S.Armed Forces, 11/17/2023 27 Years War or Dates i_ Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W Manner of Death Undetermined Pending W IEINatural Cause Accident Homicide Suicide g Circumstances Investigation W Medical Certifier Name Title CI Asim Chaudry MD 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 543 Burial Date Cemetery,Crematory or Facility Name 11/22/2023 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 4. Date Point of Cl) Transportation p by Common Shipment Carrier Destination Ei Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom H 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 11/21/2023 Registrar of Vital Statistics fMegan Nolin(ECectronica[TySigned) (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: W Date of Disposition /J-Z$-z',i 3 Place of Disposition i J e t\e vJ CC-4IVt ci'�C 2 (address) W N CC (section) (tot nu Tber) (grave number) 8 Name of Sexton or Person in Cha a of Pr mis )') jfv-i) WeitOcA Z (please print) W Signature f—7/1 1Y 1 Title II pe '''`-+r— DOH-1555(07/18)p 1 of 2 1 76�.� 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#