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Holbrook, Angela Vedder NEWYORKSTATEDEPARTMENTOFHEALTH Burial ' Bureau of Vital Records Transit Permit Name First Middle Last Sex Angela Vedder Holbrook Female Date of Death Age If Veteran of U.S.Armed Forces, 12/31/2023 92 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital W Manner of Death Natural Cause EAccident Homicide Suicide Undetermined ❑Pending U Circumstances Investigation LU Medical Certifier Name Title Sean Bain 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 622 Burial Date Cemetery,Crematory or Facility Name 01/08/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held F Hold Address 0 a. Date Point of Cl)❑Transportation El 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 W a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/08/2024 Registrar of Vital Statistics Megan Wolin(E(ectronicaltySigned) (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: H W Date of Disposition t/Cl(J.o 4 Place of Disposition rtJ V;t,j ( t t, t kcY 2 (address) W CC N (section) (lot number) (grave number) 0 Name of Sexton or Person'n Charge of Premises T f' '_ S :�� Z (please print) tL Signature // Title Lr's'NkC DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) .` �_ 1 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#