Armstrong, Virigina M. �s3
NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Virginia M.Armstrong Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/18/2020 95 Years War or Dates
�.. Place of Death Hospital,Institution or
WCity,Town or Village Johnsbur Town Street Address Elderwood at North Creek
p Manner of Death ®Natural Cause Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
13 Michael Miles MD
Address
112 Ski Bowl Rd,Johnsburg Town,New York 12853
Death Certificate Filed District Number Register Number
City,Town or Village North Creek 5655 9
❑Burial Date Cemetery,Crematory or Facility Name
03/23/2020 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
O
d Date Point of
NFiTransportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
❑Reinterment I 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
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n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/20/2020 Registrar of Vital Statistics Wgthfeen C.Gorah(Ekctronically Signed
/signature/
District Number 5655 Place North Creek, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition �_ 2��p Place of Disposition O f^
uj (ad res,)
W
N cc (section) (lot number) (gra ve number)
Name of Sexton or PersoZChn a of Premise t
Z (please print)
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Signature e Title O
DOH-1555(07/18)P t of 2
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Public Health Law Sec. 4145(2b) j 134 4 ii
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Receipt
Human remains of delivered on^ , 20
s
f• f
Pine View Cemetery Representing,the funeral home named on burial permit
Official Funeral Directors Reg.or License#
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