Bauer, Elsa NEW YORK STATE DEPARTMENT OF HEALTH 2.04
Vital Records Section Burial - Transit Permit
Name First Middle • Last Sex
Elsa Bauer Female
Date of Death Age If Veteran of U.S. Armed Forces,
04/18/2011 F 6 years War or Dates
Place of Death Hospital, Institution or
City, To �✓i Street Address
Glens Falls 45 McDonald Street
Manner�ath j Natural Cause I=1 Accident El Homicide 0 Suicide 0Undetermined ri Pending tij
Circumstances Investigation
ill Medical Certifier Name Title
John Sawyer M d
Address
14 Manor Drive, Queensbury NY 12804
Death Certificate Filed District Number Register Number
City, TowftitiiiyattxxGlens Fails 5A01 182
❑Burial Date Cemetery or Crematory
❑Entombment Oa/2t7/9(111 Pine View Crematorium
Address
❑Cremation Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
❑and/or
E,; Address
CO
Hold
0 Date Point of
ori Transportation❑ p Shipment
0 by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D. Baker Funeral Home 01149
Address
11 Lafayette Street Queensbury. N Y 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
to
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/19/2011 Registrar of Vital Statistics ;�,' 1,-
C" 0'`'c gnaturel'1 i
District Number 5601 Place Glens Falls tit y
14
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
tI Date of Disposition 4-2I-II Place of Disposition -PineU,vi„) Cn ri,itvc,4r�
(address)
Itit
CC (section) 1 - (lot number) (grave number)
0
i Name of Sexton or P son in Charg of Premises r•i r- .5c....i t
f (please print)
Signature I C E
9 �''bi� Title R M��,,ff��--
`tom'_
(over)
DOH-1555 (02/2004)