Allen-Decker, Betty L. NEW YORK STATE DEPARTMENT OF HEXL7H
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Retty
Date of Death Allen-decker
Female
Age If Veteran of U.S. Armed Forces,
63 War or Dates
Place o eat Hospital, Institution or
City, To VilfnrinStreet Address
Manner o atural Cause Accident ❑Homicide ❑Suicide n etermined ❑Pending
Circumstances Investigation
.� Medical Certifier Name Title
Ad
Srins
Death Certificate Filed District Number Register Number
City, To V
❑Burial Date Cemetery or Crematory
❑Entombment Address
❑ remation
Ouse nsh
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
Address
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Iu
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued Registrar of Vital Statistics
(signature)
District Number Place
�1591 Saratoga-Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition ///2,2 Iq Place of Dispositiontu 'PI-�,
'u (address)
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises n, Wf
(p/ se print)"
4
Signature ,,fir- Title fib
(over)
DOH-1555 (02/2004)
Public Health Law Sec. 4145(2b) 013100
Receipt
1 r
I
Human remains of E K`s delivered on , 20
Ij
Pine View dimeiery 16presenting the funeral home named on burial permit
Official Funeral Directors Reg.or License# j'