Loading...
Baker, Lorraine L 103`1 . ,t* NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Lorraine L.Baker Female Date of Death Age If Veteran of U.S.Armed Forces, 12/20/2023 77 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Stony Creek Town Street Address 480 Harrisburg Road,Stony Creek Town, New York 12878 p Manner of Death ❑X Natural Cause Accident Homicide ESuicide FlUndetermined Pending W C.) Circumstances Investigation IL/ Medical Certifier Name Title CI John Pezzulo DO Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed Town Of Stony Creek District Number Register Number City,Town or Village 5658 2 Burial Date Cemetery,Crematory or Facility Nam 12/22/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held F Hold Address CO 0 O. Date Point of ETransportation Shipment by Common Carrier Destination Date Cemetery Address Disinterment Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500,Lake Luzerne,New York 12846 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 2 Address CC ILI a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/21/2023 Registrar of Vital Statistics Susan I H arrington(Electronically Signed) (signature) District Number 5658 Place Town Of Stony Creek I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I-- Lf'`/' Z Date of Disposition I) I f:d.-3 Place of Disposition t n ./k t, �✓ �.I.) `.,fcv�T[U 2 (address) W NCC (section) (lot number) (grave number) Name of Sexton or Per n in Charge of Premises rn t'I' S�v''s s (please print) W Signature i Title C..d(Lrcr4G r DOH-1555(07/18)pi.of 2 r , if? ) Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named op burial permit Official Funeral Directors Reg.or License#