Russell, Florence NEW YORK STATE DEPARTMENT OF HEALTHII
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Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Florence A. Russell - Female
Date of Death Age If Veteran of U.S. Armed Forces,
: December 29,2013 87 War or Dates
t... Place of Death Hospital, Institution or
67 City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death
�° X Natural Cause Accident 11 Homicide Suicide n Undetermined Pending
Circumstances Investigation
t: Medical Certifier Name Title
a Farhana Kamal
Address
,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 57a
El Burial Date Cemetery or Crematory
Ei Entombment December 31,2013 Pine View Crematory
Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
E Hold
N
0 Date Point of
y I I Transportation Shipment
a by Common Destination
_ Carrier
Disinterment Date Cemetery Address
f 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
>F-, Remains are Shipped, If Other than Above
. Address
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at
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Permission is hereby granted to dispose of the human remains descri ed above indi a
Date Issued / / //1p33 Registrar of Vital Statistics 11 - .
( nature)
District Number 5601 Place Glens Falls /it// /ov
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tu Date of Disposition f/3/ty Place of Disposition
"Fut& C'tw c tj(+--
UJ
(address)
U)
0 (section) A (lot umber
Q ) (grave number)
ZName of Sexton or Person in Charge of Pre ises ;,i4 f 3ev►4 -
I (pl ase print)
W Signature (A._ Title CU01}(42
(over)
DOH-1555 (02/2004)