Ross, Katherine NEW YORK STATE DEPARTMENT OF HEALTH '' ' # 7(1)Vital Records Section Burial - Transit Permit
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Name First Middle Last Sex
Katherine A. Ross Female
Date of Death Age If Veteran of U.S. Armed Forces,
September 8,2018 83 j War or Dates
° � Place of Death I Hospital, Institution or
Z. City, Town or Village Warrensbur' I Street Address 26 Rays Road
tit- Manner of Death X Natural Cause I Accident I Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Lynn Kyle PA
Address
HHHN,Warrensburg,NY 12885
Death Certificate Filed District Number RegiXer Number
City, Town or Village Warrensburg 5660 4-
I
❑Burial Date Cemetery or Crematory
September 13,2018 Pine View Crematory
Entombment Address
ii Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
2 and/or Address
Hold
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O Date Point of
NTransportation Shipment
a by Common Destination
Carrier
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 Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
1- Remains are Shipped, If Other than Above
• Address
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Permission is h re y granted to dispose of the human remain e ribed above as indicated.
Date Issued 6 Registrar of Vital Stat ticsX)" Air,
(signature)
District Number 5660 Place Warrensburg,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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w Date of Disposition iI13l1 Place of Disposition g.•U..., 1,,,.-or,,,
2 (address)
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0 (section) (lot number) (grave number)
p Name of Sexton or Person in Charge of Premises [/r., q4g- S0411q
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Signature p• Title f'ri r(,
(over)
DOH-1555 (02/2004)