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Cleveland, Lillian F ..qi.ii . # 1oz1 NEW YORK STATE DEPARTMENT OF HEALTH Burial of Vital Records - Transit Permit Name First Middle Last Sex Lillian F.Cleveland Female Date of Death Age If Veteran of U.S.Armed Forces, 12/17/2023 90 Years War or Dates f.. Place of Death Hospital,Institution or 2 City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare p' Manner of Death IZ Natural Cause Accident Homicide Suicide Undetermined Pending ILI O Circumstances Investigation LLIQ Medical Certifier Name Title Deborah Norris 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 62 Burial Date Cemetery,Crematory or Facility Name . 12/19/2023 Pine View Crematory _Entombment Address ©Cremation Queensbury Town,New York Donation Z Date Place Removed Q❑Removal and/or Held and/or Hold Address kr Transportation Date Point of p by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment 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 F- Remains are Shipped,If Other than Above Address C W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/19/2023 Registrar of Vital Statistics Shelley 9btckernon(Electronically Signed) (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: 1- W Date of Disposition 12/11173 Place of Disposition w)�6--) CD_6A'11 TOaDi/� E„ (address) W CC (section) //1 ?trot number (grave number) O Name of Sexton or Person in Charge of Pre 'ses h �� Z plefasepr7i " t/ /� la Signature Title G �?���' DOH-1555(o7/t8)p i of 2 f ..I 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# °^'