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Raymond, Anice
r -I3I NEW YORK STATE DEPARTMENT OF HEALTH I Vital Records Section Burial - Transit Permit Name First Middle Last Sex Anice M. Raymond Female Date of Death Age If Veteran of U.S. Armed Forces, September 7,2011 68 War or Dates M,. Place of Death Hospital, Institution or Z City, Town or Village Glens Falls Street Address Glens Falls Hospital Q; Manner of Death X Natural Cause I l Accident I I Homicide Suicide Undetermined Pending U- Circumstances Investigation tu Medical Certifier Name Title 0 Evangelos Pallis Dr. Address 100 Park St., Glens Falls,NY 12801 Death Certificate Filed 1 District Number Register Number City, Town or Village Glens Falls 5601 Q/ ❑Burial Date Cemetery or Crematory September 9,2011 Pine View Crematory °Entombment Address ©Cremation Quaker Rd., Queensbury,NY 12804 Date Place Removed Z I I Removal and/or Held and/or Address H Hold co O Date Point of CL N 'Transportation Shipment p by Common Destination Carrier Disinterment Date I Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander-Baker Funeral Home 00035 Address 3809 Main Street,Warrensburg,NY 12885 Name of Funeral Firm Making Disposition or to Whom Ir Remains are Shipped, If Other than Above 2° Address !t tit O. Permission is hereby granted to dispose of the human remains described above in " e . Date Issued 09 G�/�l/ Registrar of Vital Statistics //07e77�� s� nature ( 9 ) District Number 5601 Place Glens Falls i w! / / • I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z �` ui Date of Disposition 9In'l( Place of Disposition Pal vkI.► CiTAAL0Iw.W (address) co O (section) A (lot number (grave number) p• Name of Sexton or Pers in Charge of remises 0nYk r s.�if Z l'! (please print) W Signature /� Title CQ 91001' 141 TI (over) DOH-1555 (02/2004)