Allen, Brandi I ...._ 1.4.
NEW YORK STATE DEPARTMENT OF HEALTH iir33
Vital Records Section Burial - Transit Permit
a°s Name First Middle Last Sex
. Brandi Allen Female
:::
:.::,,i Date of Death Age If Veteran of U.S. Armed Forces,
„ ,? February 7,2018 25 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Warrensburg Street Address 6 Luse Lane
lit
la Manner of Death X Natural Cause —Accident n Homicide Suicide Undetermined Pending
AA: — Circumstances Investigation
id Medical Certifier Name Title
0' Dr.Paul Bachman Coroner
q Address
3767 Main Street,HHHN,Warrensburg,NY 12885
Death Certificate Filed District Number Register Number
Y City, Town or Village Warrensburg 5660 ..5
❑Burial Date Cemetery or Crematory
February 9,2018 Pine View Crematory
❑Entombment Address
E1 Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
ZZ n Removal and/or Held
and/or Address
H Hold
CO
o Date Point of
N 1 i Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
3: Permit Issued to Registration Number
'`: Name of Funeral Home Alexander-Baker Funeral Home 00037
:' Address
3809 Main Street,Warrensburg,NY 12885
: Name of Funeral Firm Making Disposition or to Whom
-1. Remains are Shipped, If Other than Above
Address
w;
, Permission is her by ranted to dispose of the hum emains d cribed above a as indicated.
Date Issued 7 Registrar of Vital atati " �� �`--%
(signature)
- District Number 5660 Place Warrensburg,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z 7(1 tit Place of Disposition Date of Disposition RA-- �:4--
2 (address)
W
U)
d' (section) (lot number (grave number)
QName of Sexton or Person in Charge of Premises /L i...... -
Z /J ( lease pnnt)
W A f!
Signature /LY Title `izowyv -
(over)
DOH-1555 (02/2004)