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Flewelling, Shirley Edith NEW YORK STATE DEPARTMENT OF HEALTH L Trir- Bureau of Vital Records LP Burial - Transit Permit Name First Middle Last Sex Shirley Edith Flewelling Female Date of Death Age If Veteran of U.S.Armed Forces, 03/20/2024 87 Years War or Dates F., Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital V Manner of Death El Natural Cause ❑Accident Homicide Suicide Li Undetermined Pending Circumstances Investigation QW Medical 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 166 Burial Date Cemetery,Crematory or Facility Name 'IIIMINI 03/22/2024 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York DDonation ZO❑Removal Date Place Removed F and/or and/or Held N Hold Address 0 a Date Point of LO❑Transportation 5 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 1— Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/22/2024 Registrar of Vital Statistics Megan Wain(ECectronica1TySigned) (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: I— W Date of Disposition 312b(1t� Place of Disposition a/6 � ` t Ay2z: 2 (address) W CO CC (section) A (lot number) C (grave number) SName of Sexton or Person in Charge o remises /(r, 4,,.. 3w1t W (blase print) Signature Title ( PC Be. DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 1 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit f Official Funeral Directors Reg.or License# -