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Baker, Crystal Robin 17) LOF NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Crystal Robin Baker Female Date of Death Age If Veteran of U.S.Armed Forces, 12/01/2023 56 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Warrensburg Town Street Address 60 Potter Brook Road,Warrensburg Town,New York 12885 Manner of Death ❑X Natural Cause Accident El Homicide Suicide Undetermined Ti Pending Circumstances Investigation W Medical Certifier Name Title 0 Agee!Gillani MD Address 100 Park St,Glens Falls,New Yorke12801 Death Certificate Filed Town Of Warrensburg District Number Register Number City,Town or Village 5660 19 EIBurial Date Cemetery,Crematory or Facility Name 12/04/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation OZ❑Removal Date Place Removed and/or and/or Held - Hold Address 0 4. Date Point of U)❑Transportation p by Common _—_ Shipment Carrier Destination EiDisinterment 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 1— Remains are Shipped,If Other than Above 2 Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/04/2023 Registrar of Vital Statistics Pamela MGCoyd(ECectronica«ySigned) /signature) District Number 5660 Place Town Of Warrensburg I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Ii— W Date of Disposition lZ/5 113 Place of Disposition -1P3'Of45 /mitI1 2 (address) W Cr (section) �(lot‘number) (grave number) S Na::: °' or Person in Cha o remises / %re Title / z-6411� DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial per • Official Funeral Directors Reg. or License#