Chruney, Geraldine 1/ II-)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Geraldine Middle Cora Lasthruney Sex Female
Date BfIR§a15 Age 63 years If Veteran of U.S. Armed Forces,
War or Dates
i•-• Place of Pi. Hospital, Institution o
��� " Glens Falls ulens Falls Hospital
tZu City, Town or v it age Street Address
Manner of Death IIatural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
U,J Circumstances Investigation
W Medical Certifier Nam Titl
%uzanne Bergin EVI D
41
Addrw67 Main Street Warrensburg, NY 12885
Death Ce X Glens Falls ' Districtber Regis Number
City, Town orv�pillage
❑Burial Date 01/22/2015 Cemetur tory •
❑Entombment Address
[1Uremation Queensbury, NY
Date Place Removed
,gEl Removal and/or Held
and/or Address
l=" Hold
Cl)
0 Date Point of
d` Transportation Shipment
t
0 by Common Destination
Carrier
❑Disinterment Date Cemetery Address •
Reinterment Date Cemetery Address
Permit Issued to Maynard D. Baker Funeral Home Registrilumber
Name of Funeral Home
Address 11 Lafayette Street Queensbury, N Y 12804
igi Name of Funeral Firm Making Disposition or to Whom
4 Remains are Shipped, If Other than Above
'„ Address
I
iti
Permission is hereby granted to dispose of the human re ins described above as indicat .
01/21/2015
Date Issued Registrar of Vital Statistics :, y--)C-2-f
(signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were isposed of in accordance with this permit on:
ILI
fek UDate of Disposition j- L2'CS Place of Disposition ,.+ C o;.,,,,,
2 (address)
Cl)ILI
CC (section) (lot number) (grave number)
Ci Name of Sexton or Person in Charge of Premises gr-1.... Si^'t
lease print)
lW Signature 4L Title nt514eVi
(over)
DOH-1555 (02/2004)