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Putnam, Sylvia NEW YORK STATE DEPARTMENT OF HEALTH t'i 13 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Sylvia R. Putnam Female Date of Death Age If Veteran of U.S. Armed Forces, 'a May 6,2015 84 War or Dates Place of Death Hospital, Institution or City, Town or Village Queensbury , Street Address Westmount Health Care Facility Manner of Death Undetermined Pending At�- X Natural Cause � !Accident Homicide Suicide Circumstances Investigation tit Medical Certifier Name Title Roslyn Socolof MD Address 14 Manor Drive,Queensbury,NY 12804 Death Certificate Filed District Number Rester Number ::_] City, Town or Village T/O Queensbury 5657 C), ❑Burial Date Cemetery or Crematory May 7,2015 Pine View Crematory Address ©Cremation Quaker Rd., Queensbury, NY 12804 Date Place Removed O I I Removal and/or Held and/or Address H Hold N O Date Point of N Transportation Shipment a by Common Destination Carrier I Disinterment Date Cemetery Address Reinterment Date Cemetery Address 1 Permit Issued to Registration Number :;a Name of Funeral Home Alexander-Baker Funeral Home 00035 :', Address -A 3809 Main Street,Warrensburg,NY 12885 Name of Funeral Firm Making Disposition or to Whom • Remains are Shipped, If Other than Above Address WI • Permission is hereby granted to dispose of the human re ains described ab e s indicated. L:)0 Date Issued am` H Registrar of Vital Statistics � � 2.1.-2—_ (signature) District Number 5657 Place T/O Queensbury,NY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z ) ui Date of Disposition 5Jttjgr Place of Disposition ,M, �r�- � (address) W re (section) � ..(lot numbed` (grave number) pName of Sexton or Person in Charge of Premises 4)1.. Z1 !(please print) W Signature Title [177A041 (over) DOH-1555(02/2004)