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Kenny, Elizabeth NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Elizabeth Gray Kenny female Date of Death Age If Veteran of U.S. Armed Forces, November 16,2016 95 War or Dates nc I-- Place of Death Hospital, Institution or ZCity, Town or Village E. Greenbush Street Address Rosewood Gardens NUrs. Home a Manner of Death®Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title Maxine Valero jr MD Address 284 Troy Rd Rensselaer,NY 12144 Death Certificate Filed District Number RegisterNumber City, Town or Village E. Greenbush L j SD ) ©Burial Date 11/18/16 Cemetery or Crematory Pineview Cemetery ❑Entombment" Address ['Cremation Queensbury,N.Y Date Place Removed Z ❑ Removal and/or Held 2 and/or Address N Hold O Date Point of ft❑Transportation Shipment G by Common Destination Carrier ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Baker Funeral Home 01130 Address 11 LaFayette St Queenbury,N.Y. 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above 2 Address CC f Permission is hereby granted to dispose of the human remains described ab ve as indic ted: Date Issued ) ` 111 I a)ic,Registrar of Vital Statistics tom- , ' ciez (signature) District Number Place — r\ t._ (,'"; —' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: tU Date of Disposition 1 1 /22/1 6 Place of Disposition Pine View Cemet-Pry, QnPPnsbury, NY (address) ll? Mohawk 169A & 170A 1 CC (section) (lot number) (grave number) et Name of Sexton or Person in Charge of Pr ises Connie L. Goedert (please print) Signature,�L ` ��' Title Cemetery Superintendent (over) DOH-1555 (02/2004)