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Hammersley, Arlene Mary NEW Y 41040 ORKSTATE DEPARTMENT OF HEALTH • C Bureau of Vital Records Burial - Transit Permit Name First Middle Last Arlene Mary Hammersley Sex Female Date of Death I Age If Veteran of U.S.Armed Forces, 12/23/2023 86 Years War or Dates Place of Death Hospital,Institution or IIJ City.Town or Village Saratoga Springs Street Address 390 Church Street,Saratoga Springs, New York 12866 p Manner of Death El Natural Cause ❑Accident El Homicide EI Suicide Undetermined Pending W Circumstances Investigation QW Medical Certifier Name Title Mirabelle Beck NP Address 394-402 Church Street,Saratoga Springs,New York 12866 Death Certificate Filed City Of Saratoga Springs District Number Register Number City,Town or Village 4501 727 RBurial Date Cemetery,Crematory or Facility Name 12/26/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York ciDonation ��Removal Date Place Removed F and/or and/or Held CO Hold Address O d Date Point of N lJTransportation a by Common Shipment Carrier Destination ODisinterment Date Cemetery Address OReinterment 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 F- Remains are Shipped,If Other than Above a Address Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/26/2023 Registrar of Vital Statistics (Dilron Moran(ECectronicatly Signed) (signature) District Number 4501 Place City Of Saratoga Springs I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IH W Date of Disposition /Z-�71v3 Place of Disposition i,'„f( /'ems C-em ,f W (address) W S (section) � (latnumber/ (grave number) Name of Sexton or Person in Charge of P mise 1r7/j„/ + �O ,Z Y p/ease print) Signature - Title . e.rrAP DOH-1555(07/18)p 1 of 2 V 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#