Baker, Aileen ' 1 326-
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
� Name First Middle Last
a'y' Sex
;, AILEEN P BAKER FEMALE
r�• Date of Death
", tt of De 1 Age If Veteran of U.S-Armed Forces,
62 War or Dates
` Place of Death Hospital,Institution
Z, City,Town or Village• City of Albany or Street Address ST. PETER'S HOSPITAL
0 Manner of Death Natural
lit ® Cause ❑ Accident 0 Homicide ❑ Suicide ❑ Undetermined Pending
tI+Medical Certifier Name Circumstances Investigation
Ti
; MD
,'�d MICHAEL DINKELS t
I Address
MD
315 S MANNING BLVD ALBANY NY 12208
,,.s Death Certificate Filed District Number Reis City,Town or Village CitY 1 Q 1 , 1051
of Albanyg ter Number
Date `
❑Burial Cemetery or Crematory
2p17
• El
Address PINEVIEW CREMATORY
•
EI Cremation QUEENSBURY, NY
Date te Place Removed
Removal and/or Held
�• ❑ and/or Address
Hold
Cl,
dTransportation Date Point of
•U) ❑ By Common Shipment
a Carrier Destination
•
Date CemeteryAddress
❑ Disinterment
El Renterment Date Cemetery Address
=- Permit Issued To
...A Name of Funeral Home ALEXANDER BAKER FH 000stration Number
Address
OQ
" � 3809 MAIN ST WARRENSBURG NY 12885
• Name of Funeral Firm Making Disposition or to Whom
r•'t•'+<\• Remains are Shipped, If Other than Above
Address „_
re
MI
:O_. Permission is hereby granted to dispose of the human remains desc b at as in tat
�- ," Date 5/9/2017
---, Issued Registrar of Vital Statistics
(sign ure)
":a District Number 101 place City of Albany, NY f
C... ./
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
l Date of Disposition S I/o 117 Place of Disposition W 1 ���iWr 4 r/'
tl'Y�Qtf�l tV�
(address)
w
co
Q. ((ssection) I(lot number) (grave number)
ILI
Z Name of Sexton or Person in Charge of Premises / ) it -S"11f
,r
�, (please print)
Signature it` _ Title /REMICK,
(over)
DOH-1555(02/2004)