Todenhagen, Gertrude NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
fit Name First Middle Last Sex
Gertrude Arlene Todenha,en Female
ti Date of Death Age If Veteran of U.S. Armed Forces,
08/16/2017 97 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitati
-. Manner of Death r Natural Cause 0 Accident 0 Homicide 0 Suicide El Undetermined ri Pending
.
Circumstances Investigation
Medical Certifier Name Title
Gwendolyn Morris-Dickinson PA
ED Address
WS 170 Warren St,Glens Falls,New York 12801
IA
if Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 440
`LIBurial Date Cemetery or Crematory
08/21/2017 Pine View Crematory
- ,❑Entombment Address
-. ®Cremation Queensbury Town, New York
Date Place Removed
Removal and/or Held
and/or Address -
Hold
Date Point of
Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
vtAk
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Vat
iaY Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
f Address
Permission is hereby granted to dispose of the human remains described above as indicated.
.402
Date Issued 08/21/2017 Registrar of Vital Statistics gg6ert A Curtis E&tronicafysigned
Pv (signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 2i Place of Disposition evftftei Or iv—
:
(address)
iad
(section) (lotnumber) (grave number)
a Name of Sexton or Person in Charge of Premises di (p/ se print)
r �'�11+
Signature V Title `e6141\10L
(over)
DOH-1555 (02/2004)