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Annis, Eileen k 77/ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit y ' Name First Middle Last Sex Eileen Marie Annis Female Date of Death Age If Veteran of U.S. Armed Forces, :' April 1,2018 89 War or Dates Place of Death Hospital, Institution or City, Town or Village Thurman Street Address 33 Buyce Cross Road ri Manner of Death I I I I I Undetermined Pending Natural Cause Accident Homicide Suicide Circumstances Investigation Medical Certifier Name Title Michael R.Bell Address HUHN,Warrensburg,NY 12885 Death Certificate Filed District Number Register Number mx .1 City, Town or Village Thurman 5659 El Burial Date Cemetery or Crematory April 4,2018 Pine View Crematory DEntombment Address ©Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed Z Removal and/or Held and/or Address H Hold Cl) O Date Point of ( Transportation Shipment a by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address s¢a Permit Issued to Registration Number Name of Funeral Home Alexander-Baker Funeral Home 00037 I Address w, 3809 Main Street,Warrensburg,NY 12885 Name of Funeral Firm Making Disposition or to Whom 1.-] Remains are Shipped, If Other than Above eAddress IX Permission is hereby granted to dispose of the human rem ' s described ove as indicated. 55:: Date Issued )6/f� Registrar of Vital Statistics C. (signature) a District Number 5659 Place T/O Thurman I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: wDate of Disposition cI l l Irg Place of Disposition e,,11— (,w} W (address) CO CL (section) A (lot nu p Name of Sexton or Person in Charge of Premises a.,dpl. ,er) (grave number) o-.t0' 11 (pease print) Signature l'✓1 4 Title (Ztli)4 - (over) DOH-1555 (02/2004)