De Long, Linda NEW YORK STATE DEPARTMENT OF HEATH ,
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Linda M.DeLong Female
Date of Death Age If Veteran of U.S. Armed Forces,
• 10/21/2017 64 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death❑ ❑ ❑ ❑ ❑Undetermined ❑Pending
�C Natural Cause Accident Homicide Suicide
Circumstances Investigation
Medical Certifier Name Title
William Cleaver MD
Address
• 100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
- City, Town or Village Glens Falls 5601 544
❑Burial Date Cemetery or Crematory
10/23/2017 Pine View Crematory
Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
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 St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
- Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/23/2017 Registrar of Vital Statistics W,6ertACurtis ECectronualTySigned-
(signature)
District Number 5601 Place Glens Falls, New York
Tit
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition (0 JlM(q Place of Disposition � /14,411or'�^�.
=� (address)
(section) (lot number) (grave number)
Name of Sexton or Person in Charge o Premises (4r,; Sf^1at
•' (p/ se print)
Signature 'mot +tEi Title rfinvit
(over)
DOH-1555 (02/2004)