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Paige, Linda l# 5Gi2 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Linda Paige Female Date of Death Age If Veteran of U.S. Armed Forces, November 29,2011 67 War or Dates Place of Death Hospital, Institution irondack Trii-County Health Care Z City, Town or Village Johnsburg Street Address Center ©a Manner of Death X Natural Cause Accident n Homicide Suicide Undetermined Pending W Circumstances Investigation lij Medical Certifier Name Title O Daniel Way Address HHHN,North Creek,NY 12853 Death Certificate Filed District Number Register Number City, Town or Village Johnsburg 5655 '`t/ ❑Burial Date Cemetery or Crematory December 1,2011 Pine View Crematory Entombment Address ®Cremation Quaker Rd., Queensbury, NY 12804 Date Place Removed ZO I I Removal and/or Held and/or Address E Hold u) O Date Point of N 1 I Transportation Shipment p 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 Address 3809 Main Street,Warrensburg,NY 12885 Name of Funeral Firm Making Disposition or to Whom }- Remains are Shipped, If Other than Above Mason Funeral Home 2 Address fg 18 George Street,Fort Ann,NY 12827 Permission is/hereby granted to dispose of the human rema-ns described a;jre as indicated. Date Issued i 3U o2��� Registrar of Vital Statistics C/C_�� C g �' az._. l ( (signature) District Number 5655 Place Johnsburg I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: w Date of Disposition D 112aI Place of Disposition 4Ae1v E ori:w- (address) W Cl) Ce (section) (lot nu er) (grave number) pName of Sexton or Person in Charge Premises A sil S t'Kik W (please print) Signature (� Title lQ Ein WrOg (over) DOH-1555 (02/2004)