Loading...
Rajkowski, Jean fi q z6 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section --_, t Burial - Transit Permit Name First Middle Last Sex A Jean E.Rajkowski Female Date of Death Age If Veteran of U.S. Armed Forces, bas 11/25/2017 90 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ri❑Pending Circumstances Investigation a r Medical Certifier Name Title Edit Masaba MD Address 4573 State Route 40,Argyle Town, New York 12809 Death Certificate Filed District Number Register Number A: City, Town or Village Argyle 5750 32 _.❑Burial Date Cemetery or Crematory 12/01/2017 Pine View Crematory = ❑Entombment Address YY"®Cremation Queensbury Town, New York Date Place Removed 1-1 Removal and/or Held and/or Address Hold Date Point of ❑Transportation Shipment by Common Destination Carrier sal ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 = Address 24 Church Street PO Box 500, Lake Luzerne, New York 12846 au Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address '� n Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/27/2017 Registrar of Vital Statistics skelley9ttkemon ElectronicaaySigned (signature) District Number 5750 Place Argyle, New York 410, va I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition / --'/J Place of Disposition P,?- e-1i,"644) Zr2:,--14.4'7 (address) (section) (lot numr) (grave number) Name of Sexton or r .n Charge f Premises i Iti 1/ "4 - 2 (please print) Signature Title e.:/'Q kern,.'4v/— (over) DOH-1555 (02/2004)