Hauser, Priscilla •
NEW YORK STATE DEPARTMENT OF.HEALTH 13' 1
Vital Records Section 1 f Burial - Transit Permit
t -
Name First Middle Last Sex
Priscilla Rose Hauser Female
Date of Death Age It Veteran of U.S. Armed Forces,
07/ 0/2012 70 ye War or Dates No _
I- Place ot Death Hospital, Institution or
till 'City, To vraxx SchenectadyStreet Address Ellis Hospital
0 Manner o eath El Natural Cause Accident Homicide Suicide Undetermined Pending
ILL V Circumstances Investigation
ui Medical Certifier Name Title
Anthony lannuncino M D
Address
124 Rosa Rd, Schenectady, N Y 12308
Death Certificate Filed District Number Register Number
City, Tow Vj ; x SchPnPctarly 4601 667
iyio Burial Date Cemetery or Crematory
[]Entombment 07125I2012 Pine View Crematory
Address
` Q remation
Queensbury. N Y
Date Place Removed
2 Removal and/or Held
fl❑and/or
� AddressLT
f
Hold
0 Date Point of
llL 0Transportation Shipment
G>. by Common Destination
Carrier
Q Disinterment Date Cemetery Address
iffiQ Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01203
Address
•
11 Lafayette Street, Queensbury, New York
Name of Funeral Firm Making Disposition or to Whom
f4i, Remains are Shipped, If Other than Above
Address
tt
l4
It Permission is hereby granted to dispose of the human remains de ibe abo as,i ' ted.
Date Issued 07/23/2012 Registrar of Vital Statistics '� i
(pignature)
District Number 4601 Place Schenectady
kI certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
� r`
tu Date of Disposition -)-ZL-it Place of Disposition -RAW C'ro-lorfv1.-
2 (address)
ill
CO
CC (section) (lot number) (grave number)
0
0 Name of Sexton or Person in Charge o Premises r ) r' Sl, h'
f(please print)
Signature AL__
Title CtiM -i4C,
(over)
DOH-1555 (02/2004)