Hedger, Helen `,[ 4 So4Y
NEW YORK STATE DEPARTMENT OF HEALTH -
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
HPIPn F• Hedger Female
Date of De7ath/201 5 Age If Veteran of U.S. Armed Forces,
72 War or Dates no
I ' Place of Death Hospital, Institution or
W 1 , TownUtti }i Lake Luzerne Street Address 253 Pleasantview Dr_
in Manner of Death Natural Cause Accident Homicide Suicide 0 Undetermined Pending
Circumstances Investigation
G Medical Certifier a Title
Jolinbuoutenburg M.D.
Glens Falls,
!dress
Death Certificate Filed District Number Registerylumber
O11:0Town oXX Lake Luz erne 5656
y
.❑Burial Date Cemetery or Crematory
7/10/2015 Pine View Crematory
DEntombment Address
rt [Cremation Queensbury, NY
4 Date Place Removed
Z Removal and/or Held
and/or Address
W. Hold
0 Date Point of
❑Transportation Shipment
by Common Destination
ivi Carrier
Disinterment Date Cemetery Address
FR
❑Reinterment
Date Cemetery Address
Permit Issued to Brewer Funeral Home, Inc. Registration Number
1 Name of Funeral Home 00211
Address
24 Church St. , Lake Luzerne, NY 12846
x Name of Funeral Firm Making Disposition or to Whom
I_ Remains are Shipped, If Other than Above
2 Address
LU
111 Permission is hereby granted to dispose of the hu n emains des ed a.1•ve,•s indicated.
10 1 Date Issued 2%-0 j-2/5-Registrar of Vital Statis cs [ - Al / t1,t-Pi-
/ (signature)
'. District Number 6 Z, Place �-lil6 La
HI certify that the remains of the decedent identified above e disposed of in accordance with this permit on:
Z
LU Date of Disposition li1)Ii5" Place of Disposition g4tsV e , Crs..n°fdf1.—.
2 (address)
W
N
0 (section) 4 (lot number) (grave number)
p Name of Sexton or Person in Char a of Premises `44 )n'+i
at-
Z (pleas riot)
lJ.l Signature !1� Title ' i 1�V
(over)
DOH-1555 (02/2004)