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Brunetto, Elsie it .gog NEW YORK STATE DEPARTMENT OF HEALTH r W Vital Records Section Burial - Transit Permit Name First Middle Last ` Sex ;, Elsie gig Agnes Brunetto Female K Date of Death Age If Veteran of U.S. Armed Forces, tV December 23,2014 92 War or Dates ;. Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death X Natural Cause Accident n Homicide , Suicide n Undetermined 'Pending Circumstances Investigation Medical Certifier Name A / !k Title a Aopiress :..,x, ro4c- Sc-- 61 s li .::: Death Certificate Filed P ict Nu ber Register Number City, Town or Village Glens Falls 590 ❑Burial Date Cemetery or Crematory ❑Entombment December 29,2014 Pine View Crematory Address ©Cremation 21 Quaker Rd., Queensbury,NY 12804 Date Place Removed z C Removal and/or Held and/or Address F- Hold co O Date Point of N Transportation Shipment a by Common Destination Carrier ri Disinterment Date Cemetery Address Reinterment Date Cemetery Address _m, Permit Issued to Registration Number Vi I 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 o- Remains are Shipped, If Other than Above Address ti- Permission is hereby granted to dispose of the human remains escri e °bov ndicated. �.-,:, Date Issued /Z/ZyfZQ/g Registrar of Vital Statistics " (signature) ��s ''* District Number Place �a� c�(o©� 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 t L(34iy Place of Disposition "v U<4., Crvcv 4oro-- 2 (address) co x (section) (I umber) e (grave number) pName of Sexton or Person in Charge of Premises Citr� St"fir Z' (please rint) w Signature v` Title 4I7t r7 - (over) DOH-1555 (02/2004)