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Tropper, Florence NEW YORK STATE DEPARTMENT OF HEALTH - --- 1 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Florence L. Tropper Female Date of Death Age If veteran of U.S.Armed Forces, May 2,2011 101 War or Dates N/A H Place of Death Hospital, Institution or Lake Placid W City,Town or Village Street Address Adirondack Medical Center-Uihlein 0 Manner of Death ❑ Natural Cause ❑Accident ❑Homicide ESuicide ❑Undetermined ❑ Pending Z Circumstances Investigation W Medical Certifier Name Title i.,i W Mandeep Saluja MD. to Address AMC-Uihlein, 185 Old Military Rd. Lake Placid,NY. 12946 Death Certificate Filed District Number Register Number City Town,Village North Elba 1560 Date Cemetery or Crematory ❑ Burial 5/6/2011 Pine View Crematory Address ©Cremation 21 Quaker Rd. Glens Falls, NY Date Place Removed ZI Removal and/or Held H and/or Address ( Hold 0 Date Point of Shipment co) ❑Transportation p by Common Destination Carrier Date Cemetery Address ❑ Disinterment Date Cemetery Address ❑ Reinterment — Permit Issued to Registration Number Name of Funeral Director M. B. Clark, Inc. 01094 Address 2310 Saranac Avenue Lake Placid, NY 12946 Name of Funeral Firm Making Disposition or to Whom 1.= Remains are Shipped, If Other than Above 2 Address Ce a Permission is hereby granted to dispose of the human remains descr d abov s indi ted. Date Issued May 3, 2011 Registrar of Vital Statistics �/1,9�� ,� �t / //- w 1(7 (signat re) District Number 1560 Place /Vi V eG 1 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition c 1-ti Place of Disposition Pine View Crematory W 2 Quaker Rd. Glens Falls, NY 12804 W (address)" O (section) (lot nu r) (grave number) O Name of Sexton or person in Char of Premises A r,y}uP1 r -hy„tl- (please print) W Signature 9 dkflv, Title C(1{;0))p t�R- DOH - 1555 (1039) p. 1 OF 2 VS - 61