Spinks, Judity Ilk
NEW YORK STATE DEPARTMENT OF HEALTH t /' y3(1
Vital Records Section Burial - Transit Permit
• Name First Middle Last Sex
Judith Ann _ Spinks Female
x• Date of Death Age If Veteran of U.S. Armed Forces,
July 7,2014 72 War or Dates
_. Place of Death Hospital, Institution or
Z City, Town or Village Chester street Address 65 Thieriot Avenue
GManner of Death n Natural Cause ACtident n Homicide n Suicide 1 Undetermined n Pending
U: Circumstances Investigation
C3' Medical Certifier Name Title
Paul Bachman
'° " Address
HHHN,Warrensburg,NY 12885
_: Death Certificate Filed District Number Register Number
f City, Town or Village T/O Chester 5652 $'
❑Burial Date Cemetery or Crematory
❑Entombment July 9, 2014 Pine View Crematory
Address
0 Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z iFl l Removal and/or Held
and/or Address
H Hold
O Date Point of
N I !Transportation Shipment
p by Common Destination
Carrier
n Disinterment Date Cemetery Address
L]Reinterment Date Cemetery Address
-s% Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
=bs° 3809 Main Street, Warrensburg,NY 12885
A;; Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above /'
2: Address
t .
ILI'
: ° Permission is hereby granted to dispose of the human r mai de cri e bove indicate .
ap'.
Date Issued 1 o J 2p/L( Registrar of Vital Statistics dAz,te `
x , (sig ature)
:$ District Number 5652 Place T/O Chester
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
• Date of Disposition 1-(I-ii-{ Place of Disposition ,;041)tc-d (ita1—
W (address)
CO
0 Oamber)(section) t amber) (grave number)
p Name of Sexton or Person i Charge of Premises r►51 h,*
Z (pleasV print)
W
Signature 2 Title CilemikroiC
(over)
DOH-1555 (02/2004)