Wright, Lsa Marie NEW YORK STATE DEPARTMENT OF HEALTH (iij Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Lisa Marie Wright Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/19/2023 62 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
O Manner of Death 0Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
O Scott Biasetti 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 599
LBurial Date Cemetery,Crematory or Facility Name
12/22/2023 Pine View Cemetery
Entombment
_ Address
Cremation Queensbury Town,New York
Donation
OZ❑Removal Date Place Removed
and/or and/or Held
H Hold Address
CD
a Date Point of
(/)EITransportation
p by Common Shipment
Carrier Destination
Disinterment 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
Q
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/20/2023 Registrar of Vital Statistics Wegan.Noi'n(ECectronicatrySigned)
(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:
Ii—
Z Date of Disposition Place of Disposition vc, R c.) L., jc—c,.-is\ i N i LU
(address)
N11)R,c� / c i_ /
Q (section) (lot number) (grave number)
gName of Sexton or Person in Charge of Premisesc----- --,.---o ter;c- z, ck2 I-
Z (please print)
W Signature /e.#44t.i4. L(4X ' ' '
Title IDL � jc-:r1,l ,t -..1\_*,
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
!r
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
WRIGHT
Owner IF
Lisa Wright Dss
Address Plot
4 Garner St. Glens Falls, NY 17801 Horicon
Phone # Lot #
518-801 -2490 Brother Gary Armstrong 20F
Deed # Date
4423 12 .22.23
Cost Foundation Y - N
$800.00
Location West-Vacant
East-Bouer
North-Vacant
South-Rozakis
Remarks
I ACKNOWLEDGE THE RECEIPT OF THE RULES AND REGULATIONS OF THE
PINE VIEW CEMETERY:
SIGNATURE: DATE:
/1/1r
SIGNATURE: DATE:
Record of Interments
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WRIGHT
NAME Lisa Marie Wright • :e: 62
Lot Owner: Lisa Wright
Lot# Horicon 20F Grave# 1
Case: Concrete
Died: 1 2. 1 9.2 3 Interred: 1 2.2 2.2 3
Funeral Home: Baker FH
Cemetery: Pine View