Amodeo, Lillian # 5S
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Lillian E. Amodeo Female
Date of Death Age If Veteran of U.S. Armed Forces,
February 3,2011 92 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
pManner of Death X,Natural Cause Accident I I Homicide Suicide Undetermined Pending
91 Circumstances Investigation
w' Medical Certifier Name Title
Farhana Kamal MD
Address
,Glens Falls,NY 12801
Death Certificate Filed District Number Regi 'crber
City, Town or Village Glens Falls 5601
E Burial Date Cemetery or Crematory
February 4,2011 Pine View Crematory
III Entombment Address
❑x Cremation Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
N
0 Date Point of
N 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
Address
Ce
Ctil
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued Z/'.{ /I f Registrar of Vital Statistics kjV CA.A-h-._
(sig
District Number 5601 Place Glens Falls , N Y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
uiDate of Disposition F�=Mpi MI Place of Disposition -P tkr.." ,,,.,c tor�,,"
Ili (address)
U)
CL (section) /j (lot n er) (grave number)
Q Name of Sexton or Person in Charge o Premises Ihrws-.11 ;IA
Z / (please print)
W Signature dtrk, , Title (QC el Fr)2
(over)
DOH-1555 (02/2004)