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Baker, Jean Ruth 4,...z.F.` - # 92 NEW YORK STATE DEPARTMENT OF HEALTH --` Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Jean Ruth Baker Female Date of Death Age If Veteran of U.S.Armed Forces, 01/08/2024 84 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing LU p Manner of Death IZ Natural Cause Accident Ej Homicide Suicide nUndetermined Pending W Circumstances Investigation W Medical Certifier Name Title CI Jonathan Waldman MD Address 42 Gurney Ln,Queensbury Town, New York 12804 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 4 Burial Date ,Crematory or Facility Name 01/11/2024 -me View Crematory Entombment _ Address ©Cremation Queensbury Town,New York IIIDonation ZO Removal Date Place Removed and/or and/or Held i— Hold Address N 0 d Date Point of U)❑Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address IIIReinterment 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 l- Remains are Shipped,If Other than Above 2 Address CC W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/10/2024 Registrar of Vital Statistics Caroline.-fi(feganfe Barber(Electronically Signed) (signature) District Number 5657 Place Town Of Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— W Date of Disposition I/III2if Place of Disposition .�&E?v iP4414rpEs�� 2 (address) MI CCCC (section) (lot number) - (grave number) 0 Z Name of Sexton or Person in Charge of Prem' es r.� ^'f Z (ple e print Ill FrTitle `FrM'a- DOH-1555(07/18)p 1 of 2 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#