Sanders, Alma . .... ,._ e-A,0
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Alma Jane Sanders Female
>a Date of Death Age If Veteran of U.S. Armed Forces,
October 17,2015 65 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 Accident I I Homicide Suicide Undetermined Pending
J° Circumstances Investigation
w Medical Certifier Name Title
(?. Howard E. Silverberg
Address
100 Park Street,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 Y V
❑Burial Date Cemetery or Crematory
October 20,2015 Pine View Crematory
❑Entombment Address
LI Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
1:: Hold
U)
0 Date Point of
NTransportation 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 00037
Address
3809 Main Street, Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2s Address
x
w
Cl.
Permission is hereby granted to dispose of the human remains described above as indicated.
w
Date Issued )0/ i 9/15 Registrar of Vital Statistics IA) eA,.A,
_U , (signatu )
` 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:
W Date of Disposition I0/z1((1 Place of Disposition Eng., C, or„s.•.
2 (address)
W
N
ce (section) // (lot number) (grave number)
pName of Sexton or Person in Charge of Premises hr� Jtiarrl-
Z /��J�� (please print)
w Signature G� / , TitleMt-
(over)
DOH-1555 (02/2004)