Putnam, Karen NEW YORK STATE DEPARTMENT OF HEALTH • 5-7 V
Vital Records Section Burial - Transit Permit
in Name First Middle Last Sex
Karen Putnam Female
Date of Death Age If Veteran of U.S. Armed Forces,
in December 20, 2006 46 War or Dates no
Place of Death Hospital, Institution or
City, Town or Village City Glens Falls , Street Address Glens Falls Hospital
Manner of Death®Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
ILI Medical Certifier Name Title
fa Dr . Nancy Carney Physician
Address
HHHN, Warrensburg, NY 12885
Death Certificate Filed District Number / Register Number .
L'
`> City, Town or Village City/ Glens Falls 5 ( 4 V
Date Cemetery or Crematory
❑Burial 12/21/2006 Pine View Crematory
Address
®Cremation Town of Queensbury, NY
Date Place Removed
❑Removal and/or Held
— and/or Address
aHold
• 0 Date Point of
tth Q Transportation Shipment
is by Common Destination
Carrier
Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address V
Permit Issued to Alexander-Baker Funeral Home Registration Number
s Name of Funeral Home 00036
iiii: Address
3809 Main St. , Warrensburg , NY 12885
t Name of Funeral Firm Making Disposition or to Whom
h" Remains are Shipped, If Other than Above
klig Address
�:.<:1 Permission is hereby granted to dispose of the human remains described above as indicated.
RI
Date Issued 12/21/2006 Registrar of Vital Statistics h�A.$)--A C.c, f u k,:,
(signature)
>' District Number56O ( - Place 6j S -r-. 1 \ , ivy
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
.
ii Date of Disposition 12/2?/o( Place of Disposition -(9,,i it/.0%.4 (rcr-a t ci i 'k
L2L! (address)
U)
GLe (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises C!r,s S e n n c 0-
1 , l, (please print)
L .: Signature i. 4, � - Title Cam i: r
(over)
DOH-1555 (9/98)