Ovitt, Betty z10
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
K: Name First Middle Last Sex
n`` Betty M. Ovitt Female
:.. : Date of Death Age If Veteran of U.S. Armed Forces,
4 March 12,2017 82 War or Dates
Place of Death Hospital, Institutioriirondack Tri-County Health Care
City, Town or Village Johnsburg Street Address Center
lkk
Manner of Death n Natural Cause ❑Accident n Homicide n Suicide ❑Undetermined n Pending
at Circumstances Investigation
w Medical Certifier Name Title
p c,) its •/ %�G�SM fv/l�
r . tc Kd Address
/74/ eirak / .....d 7?7
,i Death C ificate Filed
�ry � ( District Number Register Number
.,,, Cit Village ��C'ili6blki �-/
❑Burial Date Cemetery or Crematory
❑Entombment March 14,2017 Pine View Crematory
Address
®Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
ZO C Removal and/or Held
and/or Address
H Hold
Cl)
0 Date Point of
N n Transportation Shipment
a by Common Destination
Carrier
n Disinterment Date Cemetery Address
PI Renterment Date Cemetery Address
:;_ Permit Issued to Registration Number
sY; Name of Funeral Home Alexander-Baker Funeral Home 00034
;Rs Address
a 3809 Main Street, Warrensburg,NY 12885
s,° Name of Funeral Firm Making Disposition or to Whom
'aH`,,,�`�„ Remains are Shipped, If Other than Above
Address
3_ Permission is hereby granted to dispose of the human re • s described above a indicated.
ti° Date Issued .S- ) Registrar of Vital Statistics �,_. _
fix.:. (signature)
qi° District Number 97‘ - Place i f,,b,,,1�,, q , AJ
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w_ Date of Disposition 3115 in Place of Disposition Fiot V,�., C ON)►..
W (address)
N
Cd (section) (lot number) (grave number)
O //
ZZ Name of Sexton or Person in Charge of Premises ` ws CP c 1 t it
Ill ,/ (ple se print)
Signature L Title (W11 ,{ 2
(over)
DOH-1555 (02/2004)