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Rafferty, Laura E. #316 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Laura E.Rafferty Female Date of Death Age If Veteran of U.S Armed Forces, 04/18/2020 76 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Warrensburg Town Street Address 137 Library Avenue,Warrensburg Town, New York 12885 p Manner of Death © Natural Cause Accident Homicide Suicide Undetermined Pending UCircumstances Investigation UU Medical Certifier Name Title Umbreen Rozell MD Address 100 Park Street,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Warrensburg 5660 8 Burial Date Cemetery,Crematory or Facility Name 04/22/2020 Pine View Crematory Entombment Address Cremation Queensbury Town,New York Donation OZ Removal Date Place Removed and/or and/or Held N Hold Address O a Date Point of fR ❑Transportation p by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address ❑Reinterment 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 orto Whom Remains are Shipped,If Other than Above Address W C' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/21/2020 Registrar of Vital Statistics Pamela M GCoyd(ECectronically Signet() (signature) District Number 5660 Place Warrensburg, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F— W Date of Disposition Z/-Z1 ZO 7- Place of Disposition y?,tL V jreweG.�zi LU /address/ W N M (section) (tot number) (grave number) SName of Sexton or Person' e of Premises 64-hR e.-c- z Z (Please print) W Signature A Title DO H-1555(o7/18)p i o 2 Public Health Law Sec. 4145(2b) — p-j"'�+ Receipt Human remains of delivered on ` , 20 r Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# r