Gadway, Rosalyn 1741
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
:-- Name First Middle Last Sex
Rosalyn E. Gadway Female
Date of Death Age If Veteran of U.S. Armed Forces,
`4. March 5,2016 68 War or Dates
Place of Death Hospital, Institution or
i City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death X]Natural Cause I I Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
E0'
w Medical Certifier Name Title
: Jennifer Stratton
Address
=_ ,Glens Falls,NY 12801
Death Certificate Filed District Number Registrffiber
City, Town or Village CIO Glens Falls 5601
❑Burial Date Cemetery or Crematory
March 7,2016 Pine View Crematory
0 Entombment Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
to
O Date Point of
N I I Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
PI Reinterment Date Cemetery Address
-: ,' Permit Issued to Registration Number
° KKu; Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
', Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 3 1 -1 116 Registrar of Vital Statistics C2k..4--Lk%
(signature)
District Number 5601 Place C/O Glens Falls, 1V y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 3/g fit, Place of Disposition - teOft,,, Ervwci°co.,
2 (address)
W
co
cc (section) (lot numbe (grave number)
pName of Sexton or Person in Charge of Premises �r„t ►�^ 3tnnuf'
Z lease print)
W Signature �j Title evet44711
c (over)
DOH-1555 (02/2004)