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Hatch, Eleanor 0oL NEW YORK STATE DEPARTMENT OF HEALTH _ "' Vital Records Section Burial - Transit Permit Name First Middle Last Sex Eleanor C. Hatch Female Date of Death Age If Veteran of U.S.Armed Forces, November 14,2006 88 War or Dates no Place of Death Hospital, Institution or z City,Town or Village City of Glens Falls Street Address Glens Falls Hospital al G Manner of Death 0 Natural Cause El Accident ❑ Homicide ❑ Suicide El Undetermined El Pending Circumstances Investigation V Medical Certifier Name Title III a Christopher D.Hoy physician Address 102 Park Street, Glens Falls,NY 12801 Death Certificate Filed District Number Register Number f City,Town or Village City of Glens Falls 5601 5 El Burial Date Cemetery or Crematory 11/15/2006 Pine View Crematory ❑ Entombment Address © Cremation Queensbury,NY Date Place Removed z ❑ Removal and/or Held Q and/or Address F— Hold o Date Point of d ❑ Transportation Shipment N by Common Destination G Carrier Date Cemetery Address ❑ Disinterment Date Cemetery Address ❑ Renterment Permit Issued to Registration Number Name of Funeral Home Alexander Funeral Home,Inc. 00037 Address 4479 State Route 28,North River,NY 12856 Name of Funeral Finn Making Disposition or to Whom N Remains are Shipped, If Other than Above - Address It w p., Permission is hereby granted to dispose of the human remains descri a v rdi Date Issued 11/15/06 Registrar of Vital Statistics (signature) District Number 5601 Place City of Glens Falls,City Hall,Glens Falls,NY I certify that the remains of the decedent identified above were disposed of in accordance witty this permit on: I-- W Date of Disposition t i /rb/Ob Place of Disposition ?n/ 't (rarp4''°r,to it Ui (address) W (section) (lot number) (grave number) C I GName of Sexton or Person in Charge of Premises CA ris Se►rn-(tf z (please print) r al0Signature Title t�i 1-1-tsi DOH-1555(02/2004) (over)