Rogge, LInda gti
NEW YORK STATE DEPARTMENT OF HEALTH '` tr t
Vital Records Section Burial - Transit Pe emit
Name First Middle Last Sex
Linda J. Rogge Female
Date of Death Age If Veteran of U.S. Armed Forces,
October 18,2018 75 War or Dates
f„ Place of Death Hospital, Institution or
• City, Town or Village Queensbury Street Address 6 Westmore Avenue _
dManner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
w Medical Certifier Name Title
Dr.John Sawyer,MD
Address
14 Manor Drive,Queensbury,NY 12804
Death Certificate Filed District Number Register Number
City, Town or Village 5657 l LtR
❑Burial Date Cemetery or Crematory
Entombment October 19,2018 Pine View Crematory
Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
N
0 Date Point of
O.
Transportation Shipment
p 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
. Remains are Shipped, If Other than Above
2 Address
ltl=
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued (0-a.a--2.0 1 W Registrar of Vital Statistics
(signature)
District Number 5L5''j Place QV cc is
H
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
1 �{
Date of Disposition IOJZ31i3 Place of Disposition J?MIJIt-✓
(address)
W
N
(section) (lot number)c (grave number)
Name of Sexton or Person in Charge of Premises Ar•, e.i, ,fr
Z (ple'ase print)
W
Signature Title filer64
(over)
DOH-1555 (02/2004)