Rumble, Lucinda NEW YORK STATE DEPARTMENT OF HEALTH ( ' ' '4 4 tiol
Vital Records Section Burial - Transit Permit
1 Name First Middle Last Sex
Lucinda Kay Rumble Female
Date of Death Age If Veteran of U.S. Armed Forces,
June 10,2017 57 War or Dates
,, Place of Death Hospital, Institution or
2 City, Town or Village Warrensburg Street Address 4112 State Route 9
ILI
• Manner of Death X Natural Cause Accident I I Homicide Suicide Undetermined Pending
INI Circumstances Investigation
a Medical Certifier Name Title
1. Terry Como
Address
Death Certificate Filed District Number Register Number
City, Town or Village Warrensburg 5660 `�'
❑Burial Date Cemetery or Crematory
June 14,2017 Pine View Crematory
El Entombment Address
❑x Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z I I Removal and/or Held
and/or Address
H Hold
N
O Date Point of
O. Transportation Shipment
p by Common Destination
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 Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
21 Address
to
tAw
' Permission is h reby ranted to dispose of the human remains de ribe above as indicated.
Date Issued r 7Y / Registrar of Vital Sta tics
(signature)
District Number �" z,66 Place C1_ ,tiZ.,t_t___,, /11
of I certify that the remains of the decedent identified above wer flispose in accordance with this permit on:
r
p li n Disposition '� rAt..• ( 4t h
w Date of Disposition b 5( Place of a tti
2 (address)
w
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re (section) l/ (lot number) (grave number)
pName of Sexton or Person in Charge of Premises ,hr, r .c tv"
Z // (ple se print)
w Signature 6( Title egf Mv°td�
(over)
DOH-1555 (02/2004)