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Auerbach, Mioara NEW YORK STATE DEPARTMENT OF HEALTH !° 16 Pf. 33'3 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Mioara R. Auerbach Female Date of Death Age If Veteran of U.S. Armed Forces, April 23,2017 85 War or Dates Place of Death Hospital, Institution or City, Town or Village Queensbury Street Address 1 Pinewood Avenue a' Manner of Death X Natural Cause I !Accident Homicide Suicide Undetermined Pending tt Circumstances Investigation ii Medical Certifier Name Title ; i Gerard Abess Dr. Address 3 Iron Gate Center,Glens Falls,NY 12801 Death Certificate Filed District Number Re ister Number City, Town or Village Queensbury (,aS') ) ❑Burial Date Cemetery or Crematory Ill Entombment Address 1,2017 Pine View Crematory Address ©Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed Z Removal and/or Held and/or Address N Hold Cl) 0 Date Point of N Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address ._ Permit Issued to Registration Number Name of Funeral Home Alexander-Baker Funeral Home 00037 Address 3809 Main Street,Warrensburg,NY 12885 Name of Funeral Firm Making Disposition or to Whom 44. Remains are Shipped, If Other than Above 2= Address iti Permission is hereby)granted to dispose of the human reins des ribed b ve as,indicated. Date Issued 1 iod-S/ood0 1 Registrar of Vital Statistics t )C—. c n---_, (signature) District Numbe (g�') Place Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z ,,a� Lu Date of Disposition 517 I n Place of Disposition ,fr,,tli..„ [f..... ot‘w- W (address) Cl) re (section) /' (lot umber) (grave number) p Name of Sexton or Person in Charge of Prem'ses 1/�A3 , ih*,li" 'Z (ple se print) Signature 11 Title !RE InftZL (over) DOH-1555 (02/2004)