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Longonia, Jeanine Dolores NEW YORKSTATE DEPARTMENT OF HEALTH •" Burial - Transit Permit Bureau of Vital Records .` `` � r Name First Middle Last Sex Jeanine Dolores Longoria Female Date of Death Age If Veteran O(US.Armed Forces, 02/27/2024 60 Years War or Date i Place of Death 'HHoipitd�lnstitution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital 0 Manner of Death ❑X Natural Cause Accident El Homicide Suicide ❑Undetermined Pending Circumstances Investigation WMedical Certifier Name Title Marcille Labban 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 125 Burial Date Cemetery,Crematory or Facility Name 03/01/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 60 Removal Date Place Removed and/or and/or Held F- Hold Address 0 O. Date Point of Cl)❑Transportation p 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 F. Remains are Shipped,If Other than Above 2 Address Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/01/2024 Registrar of Vital Statistics Megan Nofn(EfectronicalTy Signed) (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: IH W Z Date of Disposition 3- -�d,�'./ Place of Disposition �A)P V,e u.) Citep?g y�'t-2 (address) ..___.) ILLI N (section) (lot num r) (grave number) SName of Sexton or Person in Charg f Pre is l?fi nIoie JJ� II (please print) W Signature ���1 Title G�Q r,-40 r DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) 0 Receipt Human remains of delivered on , 20 • d / Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#- —