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Carver, Joanne R if NEW YORK STATE DEPARTMENT OF HEALTH Permit Burial - Transit Bureau of Vital Records Name First Middle Last Sex Joanne R.Carver Female Date of Death Age If Veteran of U.S.Armed Forces, 12/20/2023 86 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Moreau Town Street Address 198 Bluebird Road,Moreau Town,New York 12803 p Manner of Death IZI Natural Cause Accident 0 Homicide ESuicide Undetermined Pending W Circumstances Investigation µ Medical Certifier Name Title Madison Zuis NP Address 9 Carey Road,Queensbury Town, New York 12804 Death Certificate Filed Town Of Moreau District Number Register Number City,Town or Village 4562 74 Burial Date Cemetery,Crematory or Facility Name 12/23/2023 Pine View Crematory _Entombment Address ©Cremation Queensbury Town,New York Donation Z Date Place Removed O❑Removal and/or and/or Held Hold Address 0 O. Date Point of Transportation Shipment p by Common Carrier Destination 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 F-. Remains are Shipped,If Other than Above 5 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/22/2023 Registrar of Vital Statistics Brenda Jfutter(ELectronicallySigned) (signature) District Number 4562 Place Town Of Moreau I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F WDate of Disposition /a.." -J-o'3 Place of Disposition pi t,t, If':vv.) \,rtAtoir Or' 2 (address) W C (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises �L1�'ty S�rt,=��j Z (p7ease print) W Signature &%� Title (Jr-,r,cdc( DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) • fl17737 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#