Wheeler, Linda M. '` - - '� �I
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Linda M Wheeler Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/17/2020 72 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Warrensburg Town Street Address 30 Stacy Street,Warrensburg Town, New York 12885
W13 Manner of Death
®Natural Cause Accident Homicide Suicide Undetermined ❑Pending
V Circumstances Investigation
Q Medical Certifier Name Title
Darci Gaiotti-Grubbs MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Warrensburg 5660 9
Burial Date Cemetery,Crematory or Facility Name
04/23/2020 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
" Donation
ZO ❑Removal Date Place Removed
and/or and/or Held
F-N Hold Address
O
d Date Point of
NElTransportation
p by Common Shipment
Carrier Destination
" F-1 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 or to Whom
Remains are Shipped,If Other than Above
2 Address
fY
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/22/2020 Registrar of Vital Statistics Tamela 914 LCoyd(ECectronicalCySigned)
(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-
Z Date of Disposition N 113110 Place of Disposition t�
W
(address)
W
N
c (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Pre
Z (please pri
W
Signature Title �
DO H-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 013606
Receipt
Human remains of delivered on , 20
i
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#