McAllister, Mary NEW YORK STATE DEPARTMENT OF HEALTH a - '
q
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Mary E. McAllister Female
Date of Death Age If Veteran of U.S. Armed Forces,
January 20,2011 74 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
p; Manner of Death X Natural Cause I I Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
" Medical Certifier Name Title
4_h Dr.Paul Bachman
Address
HHHN,Warrensburg,NY 12885
Death Certificate Filed District Number Reg,i_s_ierlumber
City, Town or Village Glens Falls 5601
❑Burial Date Cemetery or Crematory
January 24,2011 Pine View Crematory
Entorrtment Address
❑x Cremation Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z
Removal and/or Held
and/or Address
Hold
N
O Date Point of
O.
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
ka Remains are Shipped, If Other than Above
Address
w
Permission is ere y granted to dispose of the human remains described a ove s in ' .
Date Issued Registrar of Vital Statistics ZiaG
(signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ul Date of Disposition TAN ?I ?Qj Place of Disposition .n )IIac,) Cwo.<tdr��.
(address)
N
(section) (lot number— (grave number)
pName of Sexton or Person in Charge f Premises . k r`,s 111".
1 (please print)
W ] ��1
Signature ,iJ•.� Title CU.Mira,
(over)
DOH-1555 (02/2004)