Prosser, Deborah 11 3 Z 3
NEW YORK STATE DEPARTMENT OF HEALTIjj ., y Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Deborah Prosser Female
Date of Death Age If Veteran of U.S. Armed Forces,
May 15,2014 60 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death Undetermined Pending
E�� �X�Natural Cause Accident � �Homicide Suicide
L. Circumstances Investigation
LI
iii Medical Certifier Name Title
0 Mary Clarisse Kilayko MD
Address
6223 State Route 9,Chestertown,NY 12817
Death Certificate Filed District Number Reg giber
City, Town or Village Glens Falls 5601
❑Burial Date Cemetery or Crematory
May 21,2014 Pine View Crematory
ill Ent°111bment Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
• and/or Address
E Hold
CO
O Date Point of
NTransportation Shipment
a 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 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
t— Remains are Shipped, If Other than Above
• Address
tL
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- Permission is her by/granted to dispose of the human remains describ ab ve in c d.
Date Issued /5/2O/. Registrar of Vital Statistics
(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:
W Date of Disposition 5-L vN Place of Disposition ?Utw 6040 iv.
2 (address)
W
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re
0 (section) /4... (lot numb (grave number)
p Name of Sexton or Pers%ç;L
in Charge Premises ,itr. 3/eiN rt
z (please print)
W SignatureTitle
(over)
DOH-1555 (02/2004)