Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Tubbs, Edith M.
. I if II081, NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Edith M.Tubbs Female Date of Death Age If Veteran of U.S.Armed Forces, 10/06/2020 82 Years War or Dates i. Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing W Manner of Death Pending � ©Natural Cause �Accident �Homicide �Suicide �Undetermined � W V Circumstances Investigation W Medical Certifier Name Title 0 Jennifer Donovan DO Address 42 Gurney Ln,Queensbury Town, New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 188 ElBurial Date Cemetery,Crematory or Facility Name 10/07/2020 Pine View Crematory Ej Entombment Address X❑Cremation Queensbury Town,New York ▪Donation Z Removal Date Place Removed O Eland/or and/or Held ~ Hold Address CO 0 a Date Point of Cl) Li Transportation Shipment Q by Common Carrier Destination Date Cemetery Address ❑Disinterment Date Cemetery Address ElReinterment Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500, Lake Luzerne, New York 12846 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above M Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/06/2020 Registrar of Vital Statistics Caroline Hildegarde Barber(Electronically Signed) (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 I O/SjtO Place of Disposition ��.,��t'•.� r— W (address) W N 2 (section) 11 (lot number) (grave number) O U �n• Name of Sexton or Person in Char Premises �"` ~�� (plc se print) Z , ,,.,,/1 W Signature _S Title � " DOH-1555(07/18)p id 2 Public Health Law Sec. 4145(2b) 01'4 0 Q. Receipt Human remains of delivered on , 20— Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#