Roden, Hilda 3 L
NEW YORK STATE DEPARTMENT OF HEAf.TH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Hilda D.Roden Female
Date of Death Age If Veteran of U.S. Armed Forces,
10/14/2018 91 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc
Manner of Death 0 Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Eileen Spinelli NP
Address
319 Broadway,Fort Edward Town,New York 12828
Death Certificate Filed District Number Register Number
City, Town or Village Fort Edward 5755 56
❑Burial Date Cemetery or Crematory
10/18/2018 Pine View Crematory
U Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
El 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
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/18/2018 Registrar of Vital Statistics Aimee 9Kakoney(Electronicalty Signed)
(signature)
District Number 5755 Place Fort Edward, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition go in Q Place of Disposition
(address)
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises 4^'� - J&NqM
(please p int)
ai Signature G;-f .'+�' Title %irt a1-
(over)
DOH-1555 (02/2004)