Bida, Elizabeth NEW YORK STATE DEPARTMENT OF HEALTH ' i 7 I
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Elizabeth Ann Bida Female
Date of Death Age If Veteran of U.S. Armed Forces,
October 13, 2017 67 War or Dates
F Place of Death Hospital, Institution or
�Z' City, Town or Village Warrensburg Street Address 57 Library Avenue
p Manner of Death IX'Natural Cause Accident I I Homicide Suicide Undetermined Pending
w Circumstances Investigation
w Medical Certifier Name Title
0 Michael R.Bell MD
Address
Warrensburg,NY 12885
Death Certificate Filed District Number Register Number
City, Town or Village Warrensburg 5660 /g
❑Burial Date Cemetery or Crematory
October 16,2017 Pine View Crematory
❑Entombment Address
❑x Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
V)
0 Date Point of
wTransportation Shipment
p by Common Destination
Carrier
Li Disinterment Date Cemetery Address
IReinterment Date Cemetery Address
IPermit 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
I_-: Remains are Shipped, If Other than Above
2 Address
w.
Permission is hereby granted to dispose of the human remains d cribed above as indicated.
/,J✓
Date Issued ! /J / 7 Registrar of Vital Statistics �� �Gu G
(signature)
District Number S,6 0 Place T/O Warrensburg,NY
::
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
Z
w Date of Disposition/0 -/9- /7 Place of Disposition / i QJ 1'6(4) e 7-8,-.'7e rciry
2 (address)
w
co
O (section) (lot number) (grave number)
p Name of Sexton or P n in Charge of Premises it-. / i G'_rl 64;. rnc, a Lz C
LZ ` (please print)
Signature Title 6 "e-rne_iv,'"
/ (over)
DOH-1555 (02/2004)