Kreinheder, Pearl NEW YORK STATE DEPARTMENT OF HEALTH �u
Vital Records Section 4 A. Burial - Transit Permit
Name First Middle Last Sex
Pearl I. Kreinheder Female
Date of Death Age If Veteran of U.S. Armed Forces,
' August 21,2011 94 War or Dates
Place of Death Hospital, Institution or
:Z City, Town or Village Warrensburg Street Address 3922 Main St.
.t1.1; Manner of Death Undetermined Pending
X Natural Cause Accident Homicide Suicide
V. Circumstances Investigation
Medical Certifier Name Title
i Richard P.Leach Jr
Address
28 Sherman Ave.,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number / 3
City, Town or Village Warrensburg 5660
❑Burial Date Cemetery or Crematory
Entombment August 22,2011 Pine View Crematory
Address
®Cremation Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal _ and/or Held
O and/or Address
H Hold
N
0 Date Point of
NTransportation Shipment
a 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 00035
I Address
' 3809 Main Street,Warrensburg, NY 12885
Name of Funeral Firm Making Disposition or to Whom
°I' Remains are Shipped, If Other than Above
Address
All
j Permission is hereby granted to dispose of the human rem in l'scribe above as indi ted.
Date Issued g as 1 i Registrar of Vital Statistics ,e / �//
(signatur
District Number 5660 Place Warrensburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
im Date of Disposition lijc41kl Place of Disposition T l+tctf} Crv,40,w+..
(address)
W
U)
I (section) (lot nu (grave number)
pName of Sexton or Perso in Charge of remises r ,} .fit*eta-
Z (please print)
W
Signature , . Title CatrAti 0 L.
(over)
DOH-1555 (02/2004)