Hitchcock, Elizabeth E. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Perml�
Bureau of Vital Records t,
Name First Middle Last Al"Sex
Elizabeth E.Hitchcock Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/10/2019 96 Years War or Dates
~ Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address The Stanton Nursing And Rehabilitation Centre
`p Manner of Death Natural Cause Accident 1:1Homicide Suicide Undetermined Pending
T Circumstances Investigation
W Medical Certifier Name Title
Suzanne Barth PA
Address
152 Sherman Ave,Queensbury Town,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 166
Burial Date Cemetery,Crematory or Facility Name
11/13/2019 Pine View Crematory
Entombment Address
aCremation Queensbury Town,New York
Donation
Z —T
Removal Date Place Removed
and/or and/or Held
P Hold Address
N
O
Date Point of
N Transportation
p by Common Shipment
d
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
4 Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition orto Whom
Remains are Shipped,If Other than Above
Address
Q
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/12/2019 Registrar of Vital Statistics CarvlineJ11,-fde,4ard Bader(Electronicaf Srgrredl�
(signature/
District Number 5657 Place Queensbury, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F—
Z Date of Disposition till-3115 Place of Disposition U v 4AV rv-
1V (address)
2
W
N (section) (lot number) (grave number/
Q
8Name of Sexton or Person in Charge of Pre ises
Z s (pi se print)
W Signature Title
DOH-1555(o7/18)p 1 of 2
Public Health Law Sec. 4145(2b) 0 ?0 7 4
Receipt
Human remains of J ,� 'r t` delivered on , 20
Pine View Cemetery Representing the f&era ome named on burial permit
Official Funeral Directors Reg.or License# Y `0