Parker, Tina i ..4 # S g 7
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Tina M.Parker Female
Date of Death Age If Veteran of U.S. Armed Forces,
07/17/2018 49 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Mount Pleasant Town Street Address Westchester Medical Center
- Manner of Death X❑Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ri❑Pending
Circumstances Investigation
.-, Medical Certifier Name Title
Megan Wright NP
Address
A{ 100 Woods Road,Mount Pleasant Town,New York 10595
Death Certificate Filed i District Number Register Number
City, Town or Village Valhalla 5957 467
❑Burial Date Cemetery or Crematory
07/19/2018 Pine View Crematory
iP, ❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed:
❑ _ _Removal
and/or Held
and/or Address
• Hold Ike,
s, Date Point of
,,7❑Transportation Shipment
by Common Destination
Carrier
❑Disinterment Date Cemetery Address
i:tv;',; ❑Reinterment 1 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
.a,
• Permission is hereby granted to dispose of the human remains described above as indicated.
• Date Issued 07/18/2018 Registrar of Vital Statistics 'Patricia June Scova(ECectronica1Cy Signed)
74,
(signature)
P.
District Number 5957 Place Valhalla, New York
lt
• certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition .7110 fig Place of Disposition f •11. 1 lrn„'z..J
(address)
(section) �Rt number) (grave number)
Name of Sexton or Person in Charge of Premises I (r
/ (p/eAse print)
41
Signature 4 /(/� Title tamitrivt..
(over)
DOH-1555 (02/2004)