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Galusha, Melanie M
.t.. NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Melanie M.Galusha Female Date of Death Age If Veteran of U.S.Armed Forces, 02/11/2024 63 Years War or Dates H Place of Death Hospital,Institution or WCity,Town or Village Minerva Town Street Address 681 Church Road,Minerva Town,New York 12857 p Manner of Death El Natural Cause Accident ❑Homicide Suicide Undetermined Pending W Circumstances Investigation U i1U Medical Certifier Name Title Q Kellie Valentine Coroner Address PO Box 132,Elizabethtown Town,New York 12932 Death Certificate Filed Town Of Minerva District Number Register Number City,Town or Village 1557 2 Burial Date Cemetery,Crematory or Facility Name 02/14/2024 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation Z�Removal Date Place Removed and/or and/or Held H Hold Address N 0 CL Date Point of O Dransportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address ❑Reinterment 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 H Remains are Shipped,If Other than Above 5 Address CC W 0. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/14/2024 Registrar of Vital Statistics `Theresa¶Fish(E(ectronicaftySigned) (signature) District Number 1557 Place Town Of Minerva I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I- W Date of Disposition Z(I S rx,‘,44 tZii Place of DispositionFA-) C (M4' Z "..— 2 (address) W NCC (section) (lot number (grave number) O Aq)1.-• Name of Sexton or Person in Charge Pr isesZ �►'r'JHease e pn W Signature Title ` r1 m�1K DOH-1555(07/18)p 1 of 2 ¶: 1 7 9 6_ 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#