McLaughlin, Ellen NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burk I - Transit Permit
Name First Middle Last I Sex
Ellen F. McLaughlin Female
Date of Death Age If Veteran of U.S. Armed Forces,
July 17,2015 73 War or Dates
f Place of Death , Hospital, Institution or
Z City, Town or Village Warrensburg Street Address 52 Hudson St.
a Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
w; Medical Certifier Name / Title
O. Eric Pillemer
Address
CR Wood Cancer Center,Glens Falls,NY 12801
Death Certificate Filed District Numyer Register Number
City, Town or Village T/O Warrensburg 5660
❑Burial Date Cemetery or Crematory
Entombment July 20,2015 Pine View Crematory
Address
❑X Cremation 21 Quaker Rd., Queensbury, NY 12884\
Date Place Removed
OZ Removal and"/or Held
and/or Address
H Hold
'
O Date Point of
N I 'Transportation Shipmen
a by Common 1 Destination -
Carrier
Disinterment Date Cemetery Ad
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
Remains are Shipped, If Other than Above
51 Address
it
m.
, Permission is h reby granted to dispose of the human remains scribed above asindicated.
{ Date Issued Registrar of Vital St stics v G ff�
(signature)
District Number 5660 Place T/O Warrensburg
I certify that the remains of the decedent identified above were disposed of in`�accordance with this permit on:
W• Date of Disposition ?/tt��s" Place of Disposition
2 (address)
W
CO
(t (section) (lot number)`C (grave number)
Q Name of Sexton or Person in Charge of Premises +�,f $tni%l
Ili
A (plleease print)
Signature ,.�. Title filiPiiij
(over)
DOH-1555 (02/2004)