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Bakerian, Amanda Jean I NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Amanda Jean Bakerian Female Date of Death Age If Veteran of U.S.Armed Forces, 02/08/2024 36 Years War or Dates F Place of Death Hospital,Institution or Z City,Town or Village Cambridge Village Street Address 47 Spring Street, Cambridge Village, New York 12816 ci W Manner of Death Natural Cause EAccident Homicide ESuicide Undetermined 171Pending UCircumstances Investigation Cl Medical Certifier Name Title James Gariepy Coroner Address 19 East Broadway,Salem Town, New York 12865 Death Certificate Filed Village Of Cambridge District Number Register Number City,Town or Village 5721 002 Burial Date Cemetery,Crematory or Facility Name 02/12/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation z Removal Date Place Removed and/or and/or Held Hold Address 0 d Date Point of (I)❑Transportation by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above a Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/12/2024 Registrar of Vital Statistics LanceACCen Wang(ECectronica1TySigned) (signature) District Number 5721 Place Village Of Cambridge I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 211Z(Zy Place of Disposition cv-Avvrati___ 2 (address) W CC N (section) /1)1' (lot�number) C (grave number) Name of Sexton or Person in Charge of P .ses � �t� Z please print) 1ThW Signature Title �` fi DOH-1555(07/18)p 1 of 2 1 7 r, 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#