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Ball, Sally Ann 7- 3) NEW YORK STATE DEPARTMENT OF HEALTH (jii ) Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Sally Ann Ball Female Date of Death Age If Veteran of U.S.Armed Forces, 12/31/2023 80 Years War or Dates i— Place of Death Hospital,Institution or W City,Town or Village Queensbury Town Street Address 56 John Street,Queensbury Town,New York 12804 p Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title C Robert Love MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed Town Of Queensbury District Number Register Number Ci ,Town or Village 5657 196 Burial Date Cemetery,Crematory or Facility Name 01/09/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 O. Date Point of Cl)OTransportation $ by Common Shipment Carrier Destination EIDisinterment Date Cemetery Address ElReinterment 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 i— Remains are Shipped,If Other than Above a Address EC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/09/2024 Registrar of Vital Statistics Caroline 2fi(fegardl Barber(E(ectronically 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 Date of Disposition I I l o 12' Place of Disposition Sid G''sE,.J Crrt, }10p.V).— 2 (address) W iE (section) (lot numbeg„._ (grave number) 8 Name of Sexton or Person in Charge of Premises jilt ', 6-- ��vnntfl Z /(please print) UJ Signature t2 Title 06141K 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#