Morehouse, Gail 713
NEW YORK STATE DEPARTMENT OF HEALTH,..Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Gail Ann Morehouse Female
Date of Death Age If Veteran of U.S. Armed Forces,
08/28/2018 77 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing
Manner of Death a Natural Cause 0 Accident 0 Homicide 0 Suicide ri Undetermined ri Pending
Circumstances Investigation
Medical Certifier Name Title
Roslyn Socolof MD
Address
42 Gurney Ln,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City, Town or Village Queensbury 5657 123
❑Burial Date Cemetery or Crematory
08/30/2018 Pine View Crematory
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
El❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destini on
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 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 08/29/2018 Registrar of Vital Statistics Caroline){Barber(ECectronica11ySigned)
(signature)
District Number Place
5657 Queensbury, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 1131 )i Place of Disposition ftLa ErVi"0
(address)
(section) (lot number?
(grave number)
Name of Sexton or Person in Charge of Premises_ `4n,1 pti or
Ewa " (please print)
Signature E Title M+ttU2
(over)
DOH-1555 (02/2004)