Cain, Claudette NEW YORK STATE DEPARTMENT OF HEALTH '
3A
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Claudette M. Cain Female
:,-: Date of Death Age If Veteran of U.S. Armed Forces,
: May18,2015 65 War or Dates
Place of Death Hospital, Institutiortirondack Tri.-County Health Care
f, City, Town or Village Johnsburg Street Address Center
Manner of Death Undetermined Pending
X Natural Cause Accident Homicide Suicide
Circumstances Investigation
Medical Certifier Name Title
James Hindson MD
Address
;: Main St.,Warrensburg,NY 12885
Death Certificate Filed District Number Register Number
City, Town or Village Johnsburg 5655
❑Burial Date Cemetery or Crematory
May 26,2015 Pine View Crematory
❑Entombment Address
®Cremation Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z n Removal and/or Held
9 and/or Address
F' Hold
co
0 Date Point of
NTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
,r, Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
l Name of Funeral Firm Making Disposition or to Whom
. Remains are Shipped, If Other than Above
-a Address
'et
tLl
-.- Permission is hereby granted to dispose of the human re ain described ab ve as in ca d.
Date Issued 5-20-15 Registrar of Vital Statistics Ci E ,
(signature
: District Number 5655 Place 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 rlritic Place of Disposition 4 tik. £
W (address)
N
0 (section) lot number) (grave number)
O
p Name of Sexton or Person in Charge of Premises .c St 0,121
`Z4 C/J (ple se print)
Signature ." Title lR ,
(over)
DOH-1555 (02/2004)