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Collyer, Therese Josephine NEW YORK STATE DEPARTMENT OF HEALTH r Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Therese Josephine Collyer Female Date of Death Age If Veteran of US.Armed Forces, 03/07/2024 97 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 12 Mayfield Court, Queensbury Town,New York 12804 'p Manner of Death �Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation WMedical Certifier Name Title CI Holly Bachilas MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 39 Burial Date Cemetery,Crematory or Facility Name 03/11/2024 Pine View Crematory _Entombment Address ©Cremation Queensbury Town,New York IIIDonation ❑Removal Date Place Removed and/or and/or Held F- Hold Address N 0 O. Date Point of (/) Transportation p by Common Shipment Carrier Destination oDisinterment Date Cemetery Address EIReinterment 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 CC a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/11/2024 Registrar of Vital Statistics Caroline XYdegarde Barber(ECectronica1ty 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 3111 124 Place of Disposition -Pa#,6vwv /IN fib; 2 (address) W CC (section) (lot number (grave number) Q \mac^-, g Name of Sexton or Person in Charge of Premises dt, ,fl please print) tL Signature L... Title • 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#