French, Tracy NEW YORK STATE DEPARTMENT OF HEALTH # I `1 Vital Records Section
' Burial - Transit Permit
4 Name First Middle Last Sex
Tracy L. French Female
Date of Death Age If Veteran of U.S. Armed Forces,
April 10,2012 46 War or Dates
, , Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
gyp; Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
wt Medical Certifier Name Title
Mark M.Hoffman
Address
420 Glen Street,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
1 City, Town or Village Glens Falls 5601 /6 V
❑Burial Date Cemetery or Crematory
April 12,2012 Pine View Crematory
u Entombment Address
®Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
0
0 Date Point of
N Transportation 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 00035
Address
i 3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
F Remains are Shipped, If Other than Above
2 Address
a Permission is hereby granted to dispose of the human remains descr'bed bo as i ted.
Date Issued e) /2 Zo/L' Registrar of Vital Statistics �Q� <
/ (signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
z C,W Date of Disposition �{�i2�12 Place of Disposition I�,G � orkvn.,
2 (address)
W
Ce (section) (lot num ) (grave number)
ap Name of Sexton or Person in Charge of Premises icisicplir• ew*
Z f (please print)
W Signature /1 Title CQQATtr-co�.
(over)
DOH-1555 (02/2004)