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Cameron, Alice NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Alice Louise Cameron Female Date of Death Age If Veteran of U.S. Armed Forces, December 14,2014 73 War or Dates Place of Death Hospital, InstitutiorRdton Center For Rehabilitation And Z City, Town or Village Town Of Johnstown Street Address Healthcare W Manner of Death X Natural Cause Accident I I Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title Gregory O'Keefe MD Address 847 County Highway 122,Gloversville,NY 12078 Death Certificate Filed District Number Register Nujnber City, Town or Village Town of Johnstown 1754 C/��/ ❑Burial Date Cemetery or Crematory ❑Entombment December 15,2014 Pine View Crematory Address ©Cremation Queensbury,NY Date Place Removed Z Removal and/or Held and/or Address E Hold co O Date Point of N I Transportation Shipment p 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,NY 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above 2` Address Ct lit Permission is hereby ranted to dispose of the human remain�ribed above ees ted. Date Issued / / Registrar of Vital Statistics /`� • ento (signature) District Number 1754 Place Town of Johnstown I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: us Date of Disposition Place of Disposition (address) U) (section) (lot number) (grave number) p Name of Sexton or Person in Charge of Premises Z (please print) W Signature Title (over) DOH-1555 (02/2004) Dec 15 14 12:41 p A.G.Cole Funeral Home 15187625496 p.3 4ir -77L NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Vital Records Section Name First Middle Last _ 1 Sex Alice Louise Can eron ; Female Date of Death I Age If Veteran of U.S.Armed Forces, December 14,2014 ! 73 War or Dates ' i.., Place of Death Hospital, InstftutiorF4dton Center For Rehabilitation And Z City,Town or Village Town Of Johnstown Street Address rjenitke,A e p Manner of Death 0 Natural Cause ❑Accident []Homicide I Suicide Undetermined n Pending W —Circumstances Investigation al Medical Certifier Name Title G Gregory O'Keefe MD Address 847 County Highway 122,Gloversville,NY 12078 Death Certificate Filed ' District Number I Register Number City,Town or Village Town orJohnstown 1754 j '//�`/ ❑Burial Date Cemetery or Crematory December 15,2014 Pine View Crematory Address ®Cremation Qneensbury,NY Date Place Removed Z Removal and/or Held and/or Address I' Hold N O Date I Point of N ❑Transportation I Shipment p 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,NY 12804 Name of Funeral Firm Making Disposition or to Whom i- Remains are Shipped, If Other than Above 2 Address IOC .L1 - p, Permission is hereby ranted to dispose of the human remainscd rib d abov�res iGated. Date Issued / f Registrar of Vital Statistics /r (signature) District Number 1?54 Place Town of Johnstown I certify that the remains of the decedent identified above were disposed of in ordance with this permit on: H Cart Date of Disposition IZ/niti Place of Disposition g,,.,. 4...✓ t�4ar,-... W (address) CI) Ce (section) ifot number)r (grave number) CName of Sexton or Person in harge of Pre ises cif•i}- .+ 'f' Z (yjease print) W Signature Title ('n oli4 it. (over) DOH-1555(02/2004)