Monroe, Pierrette ° 1 19 353
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Pierrette M. Monroe Female
Date of Death Age If Veteran of U.S. Armed Forces,
May 27,2015 86 War or Dates
lam. Place of Death Hospital, Institution or
City, Town or Village North Creek Street Address 9 West Holcomb St.
Iii
• Manner of Death I XI Natural Cause Accident I I Homicide Suicide Undetermined Pending
Ut Circumstances Investigation
id Medical Certifier Name Title
3° Daniel Way MD
Address
HIIIMN,North Creek,NY 12853
Death Certificate Filed DistrictNumber Register/ Number
City, Town or Village ( � � 6e
❑Burial Date Cemetery or Crematory
May 29,2015 Pine View Crematory
Ill Entombment Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
ORemoval and/or Held
and/or Address
H Hold
Cl)
O Date Point of
a.
N 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 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
11
Ct-
Permission is hereby granted to dispose of the huma re ins describ above as ica ed.
Date Issued 5- (98. stMeltegistrar of Vital Statistics ( Q,‘
,,
(signature)
District Number 5655 Place T/O Johnsburg,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 6/ i //S Place of Disposition ,,iU.,, Cr..9..--
W (address)
N
Ire (section) i(lot num r (grave number)
0
Z• Name of Sexton or Person in Charge of Premises .}jr.-
(p ase print)
w Signature 4 ,�, Title
(over)
DOH-1555 (02/2004)