Kramer, Leona ft -Or
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Leona N. Kramar Female
Date of Death Age If Veteran of U.S. Armed Forces,
May 22,2012 72 War or Dates
Place of Death Hospital, Institution or
ZCity, Town or Village Warrensburg Street Address 123 River Street
Manner of Death R Natural Cause Accident Homicide Suicide Undetermined Pending
u t Circumstances Investigation
W Medical Certifier Name Title
CI Darci Ann Gaiotti-Grubbs Dr.
Address
102 Park St.,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Warrensburg 5660 Ln
❑Burial Date Cemetery or Crematory
May 25,2012 Pine View Crematory
0 Entombment Address
❑x Cremation Quaker Rd.,Queensbury,NY 12804
Date Place Removed
Z
Removal and/or Held
and/or Address •
Hold
Cl)
0 Date Point of
a Transportation Shipment
a 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
i— Remains are Shipped, If Other than Above
2 Address
W
• Permission is hereby granted to dispose of the huma em . descri ed above as indicated.
Date Issued 0 w�3/ipl Registrar of Vital Statist s / 121
(signature)
District Number 5660 Place Warrensburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I) Caen '� Date of Disposition 5130 IIZ, Place of Disposition �•�V�v 0C I�
LL (address)
CO -
Cr (section) 1I (lot number) (grave number)
pName of Sexton or Per in Charg f Premises �hr+, >a� Sse. f
iZ //� (please print)
Signature L(/� Title CAC01A-rart,
(over)
DOH-1555 (02/2004)