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Wilkins, Gustine Elnora 4-81 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Gustine Elnora Wilkins Female Date of Death Age If Veteran of U.S.Armed Forces, 01/18/2024 58 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 234 Burke Drive D,Queensbury Town, New York 12804 pManner of Death ❑X Natural Cause Accident Homicide El Suicide Undetermined ElPending Circumstances Investigation W Medical Certifier Name Title 0 Connie Goedert Coroner Address 1400 St Route 9,Lake George Town,New York 12845 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 17 RBurial Date Cemetery,Crematory or Facility Name 01/23/2024 Pine View Crematroy Entombment Address ©Cremation Queensbury,New York DDonation ❑Removal Date Place Removed and/or and/or Held - Hold Address N 0 a Date Point of N DTransportation Shipment b by Common 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 Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/22/2024 Registrar of Vital Statistics Caroline J&egarde Barber(E(ectronica(Cy 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: Z Date of Disposition i 'a_.S/Xrj,).14 Place of Disposition ;(K) \ G(',,p 0,is y 2 (address) W (section) (lot number) (grave number) gName of Sexton or Person in Charge of Premises QC "-c Z (please print) W Signature / I Title Cd Ft-r�]0C 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#