Hill, Penny NEW YORK STATE DEPARTMENT OF HEALTH , it
7l
Vital Records Section Burial - Transit Permit
®°i�4:. Name First Middle Last Sex
k ' Penny K.
Hill Female
V Date of Death Age If Veteran of U.S. Armed Forces,
iiit November 23,2014 51 War or Dates
:,,: Place of Death
Hospital, Institution or
City, Town or Villag Glens Falls Street Address Glens Falls Hospital
Manner of Death Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifie Name Title
Paul Bachman
" h Address
� "3767 Main Street,HHHN,Warrensburg,NY 12885
�x *
= A Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls -6o 0
❑Burial Date Cemetery or Crematory
❑Entombment November 25, 2014 Pine View Crematory
Address
II Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z n Removal and/or Held
and/or Address
I Hold
cn
0 Date Point of
c1 i Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
#T Name of Funeral Home Alexander-Baker Funeral Home 00037
=T'° Address
3809 Main Street,Warrensburg,NY 12885
sA. Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
IX
iia
Permission is he eb granted to dispose of the human r ains described ab ve as i icate .
E }< Date Issued Registrar of Vital Statistics � 0 �
(signature)
District Number f� Place
J`�bV Glens Falls / A1y Pgoi
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
wDate of Disposition Moil Place of Disposition t t,,,, (ie.c °t"-" --
LLt (address)
U)
(section) /,f' (lot num (grave number)
Q Name of Sexton or Person in Charge of Premises .,;totk,. ¢ice
Z /
IliSignature A - -- Title CaF11I1IC.
(over)
DOH-1555 (02/2004)