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Griffin, Gertrude NEW YORK STATE DEPARTMENT OF HEALTH ' Z 11 Vital Records Section Burial - Transit Permit .4$, Name First Middle Last Sex A Gertrude E. Griffin Female • g• Date of Death Age If Veteran of U.S. Armed Forces, ,: March 20,2016 86 War or Dates Place of Death Hospital, Institution or • City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death X Natural Cause Accident I 'Homicide Suicide Undetermined Pending Circumstances Investigation Medical Certifier Name Title ,e. Daniel Way Address HHIIN,North Creek,NY 12853 R,• Death Certificate Filed District Number Register m 1 er City, Town or Village Glens Falls 5601 ❑Burial Date Cemetery or Crematory March 21, 2016 Pine View Crematory ❑Entombment Address ©Cremation 21 Quaker Rd., Queensbury,NY 12804 Date Place Removed Z I I Removal and/or Held and/or Address = Hold N- 0 Date Point of 1 'Transportation Shipment aa 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 00037 • Address ;? 3809 Main Street,Warrensburg,NY 12885 . a Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above 1 Address fit 4 Permission is hereby granted to dispose of the human remains describe bore in ' t d. � Date Issued ©3/Z1�Zal4. Registrar of Vital Statistics x.. (signature) District Number j60/ Place 67liw , -/� AV I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— p ( � /� W' Date of Disposition l z/ lit Place of Disposition '►K/Uw �-wenct`oN 2 (address) W CD IX (section) / (lot number)( (grave number) GName of Sexton or Person in Charge of Premises AtiJ`t - �"^ ' // //� (please print) Signature - i Title 41E04 TN (over) DOH-1555 (02/2004)