Woodruff, Vivienne NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Vivienne M. Woodruff Female
Date of Death Age If Veteran of U.S. Armed Forces,
January 15,2012 86 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Warrensburg Street Address 58 Elm St.
pManner of Death I Xl Natural Cause Accident I I Homicide Suicide Undetermined Pending
W Circumstances Investigation
Q Medical Certifier Name Title
Mark M.Hoffman
Address -_
420 Glen Street,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Warrensburg 5660
❑Burial Date Cemetery or Crematory
El Entombment i January 17,2012 Pine View Crematory
Address
Cremation Quaker Rd.,Queensbury,NY 12804
Date Place Removed
Z I I Removal and/or Held
and/or I Address
N Hold
O Date Point of
N I I Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
I _ _
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
CZ
W --
a
Permission is h reby ranted to dispose of the human mains escribed above as indicated.
Date Issued / / 7 2-0/2--Registrar of Vital Sta t'
(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:
W Date of Disposition ( /Ic /1 L Place of Disposition RN Vet 604/u,,
(address)
W
N
(section) �j • (lot numb (grave number)
pName of Sexton or Per on in Charge o Premises ` hto)(' ," pwi!
Z (please print)
lu Signature Title ((L I;M)1-TOC
(over)
DOH-1555 (02/2004)