Gendron, Pierrette NEW YORK STATE DEPARTMENT OF HEALTH t ,I # 3 3-7
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Pierrette Alvine Gendron Female
Date of Death Age If Veteran of U.S. Armed Forces,
May 5,2015 76 War or Dates
1,, Place of Death Hospital, Institution or
A. City, Town or Village Long Lake Street Address 500 Deerland Road
a Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
CA
lit Medical Certifier Name Title
Russell E.Rider MD
Address
PO Box 129,Long Lake,NY 12847-0129
Death Certificate Filed District Number Register Number
City, Town or Village T/O Long Lake � O 4
❑Burial Date Cemetery or Crematory
Entombment May 7,2015 Pine View Crematory
Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
U
0 Date Point of
NTransportation 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
I Remains are Shipped, If Other than Above
Address
AIK
s Permission is hereby granted to dispose of the human remains descr''bed above as indicated.
Date Issued 5Jt. /�4p Registrar of Vital Statistics A L � K.C��'�' 'Vt '�
j (signature)
District Number -45-
6, Place T/O Long Lake,NY
H I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z J��ry 1
W Date of Disposition S/Illy' Place of Disposition ,U.i 64,41.6...
2 (address)
W
U)
0 (section) j (lot number) , (grave number)
pName of Sexton or Person in Charge of Premises y,
Z (please print)
W Signature 4 4 Title 1774/114:)c
(over)
DOH-1555 (02/2004)