Cronin, Beverly NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Beverly J. Cronin Female
Date of Death Age If Veteran of U.S. Armed Forces,
September 29,2012 84 War or Dates
F, Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address The Pines At Glens Falls
�w Manner of Death
X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
0
uj G Medical Certifier Name Title
Roslyn Socolof
Address
100 Broad St.,Glens Falls,NY 12801
Death Certificate Filed District Number Registefp,gmber
City, Town or Village Glens Falls 5601
❑Burial Date Cemetery or Crematory
Entombment October 1,2012 Pine View Crematory
Address
0 Cremation 21 Quaker Rd.,Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
�' Hold
N
O 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
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
i— Remains are Shipped, If Other than Above
2 Address
IX
W
0-
Permission is her by granted to dispose of the human emains scribed ye as indi a.
Date Issued Id Q l �' O/o.Registrar of Vital Statistics .-e�-,/7 L�(signature)
District Number 5601 Place Glens Falls ` NY /a t)f
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
wstivs%
Date of Disposition 10 AA(iZ Place of Disposition sUu,v Cfivr
(address)
COILI
aW (section) _ ( t number) C (grave number)
Name of Sexton or Pers n in Charge of remises AN S r cjittyhat
Z please print)
Signature Title 0141- .
(over)
DOH-1555 (02/2004)