Crayford, Patricia # ..38
NEW YORK STATE DEPARTMENT OF HEALT
Vital Records Section Burial - Transit Permit
r: Name First Middle Last Sex F.
.Va#ricat f-1 nn C� r �
Date of Death Age If Veteran of U.S.Armed Forces,`�
Olio 12C?I S I U War or Dates
of Death /� �` Hospital, Institution or `e l Va\\e %_\
. City own or Village G IenS S t Street Address c:N
0 Manner of Death Laill Natural Cause []Accident 0 Homicide 0 Suicide 0 Undetermined Q Pending
Circumstances Investigation
tu Medical Certifier Name Q Title p l�
c T\ cn err ur€
. Address
3 'Yon 90-r;.:_ csu c , q lt.fA13 (cAi- %i )`-) l Z oo t
Death Certificate Filed : District Number I
Register Number
` 370
City,Town or Village )O1 .
:.v�6urial Cemetery or Crematory
08 /do 1201)6 l. P'*+1)-e \}iei3 CiNema0
[(Entombment Address R (^�
t Cremation al�. er oa (.V� tn1s burj : k\S Azg0LI
Date Place Removed
❑Removal I and/or Held
Mt__ and/or Address
Hold
IA
0 Date Point of
Di❑Transportation I Shipment
el by Common Destination
Carrier
O Disinterment Date 1 Cemetery Address
Reinterment . Date I Cemetery Address
.'.' Permit Issued to ; Baker Funeral Home Registration N o ber
Name of Funeral Home
Address
it Lafayette St., Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
a Address
tr
ttu
ft
Ams Permission is hereby granted to dispose of the human remains described above as indicated.
..- Date Issued `3161 )1 $ Registrar of Vital Statistics C 1 L`.M I
(signature)
District Number 560 ( Place tea (Q.A. `S Fo. IA 5 i tJ
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
t6f Date of Disposition d-tt ,a Place of Disposition F.,,11✓ f'„,t. ..
a (address)
ICC (section) (lot umber) (grave number)
i�
0 Name of Sexton or Person in Char of Premises //7:. r,L $a
Z (please ptihi)
Signature L Title • 112 P►14t i7_
(over)
DOH-1555 (02/2004)