Erskine, Linda , lit5 41
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Linda Louise Erskine Female
Date of Death Age If Veteran of U.S. Armed Forces,
08/27/2014 70 years War or Dates
Place of Death Hospital, Institution or
City, Towmou/iljjXX Glens Falls Street Address 19 Smith Street Glens Falls, NY 12801
11J• Manner of Death�platural Cause 0 Accident ❑Homicide 0 Suicide ❑Undetermined ❑Pending
Ul Circumstances Investigation
W Medical Certifier Name Title
41 Eric Pillemer M D
Address
100 Park Street Glens Falls, Ny 12801
Death Certificate Filed District Number Register Number
City, TowX)p( /ig( XX Glens Falls 5601 404
['Burial Date Cemetery or Crematory
❑Entombment 08/27/2014 Pine View Crematorium
Address
✓I /C,remation Queensbury, NY 12804
Date Place Removed
Z❑Removal and/or Held
C and/or Address
H Hold
0 Date Point of
Transportation Shipment
C by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D. Baker Funeral Home 01130
Address
11 Lafayette Street Queensbury, N Y 12804
Name of Funeral Firm Making Disposition or to Whom
1 Remains are Shipped, If Other than Above
2 Address
CC
LLL
IL
Permission is hereby granted to dispose of the human remains described above in d.
Date Issued 08/27/2014 Registrar of Vital Statistics ,Pd‘fot.
(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:
ILIp I Place of Disposition U Date of Disposition g z$ {�( p A ••✓t"dr
2 (address)
L
CO
CC (section) �/lot number) (grave number)
ci /
Name of Sexton or Person in Charge of Premises u"q "— -1...tit
Z (please print)
O Signature �Cr /4,--
Title CrtiEfW
(over)
DOH-1555 (02/2004)