Bredenkoff, Edna . "s
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Edna Bredenkoff , Female
Date of Death Age If Veteran of U.S.Armed Forces,
January 22,2014 91 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address The Pines At Glens Falls
ILI
p Manner of Death [Xi Natural Cause Accident E Homicide Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
Ct Rosl n Socolof
Address
100 Broad St.,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 ( t-j L/
❑Burial Date Cemetery or Crematory
El Entombment January 24,2014 Pine View Crematory
Address
Cremation Quaker Rd.,Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
` and/or Address
L- Hold
N
O Date Point of
to Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Renterment Date T 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
t_- Remains are Shipped, If Other than Above
• Address
W
Permission is hereby granted to dispose of the human remains described above,as indicated.
Date Issued 1 1 Z.'a Lt y Registrar of Vital Statistics C.A Y�Q. LA)
(signatu )
District Number 5601 Place Glens Falls ) (\
F- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tu Date of Disposition t Ate Ida _ Place of Disposition 'M L C7vwc�,r,,,.^
(address)
!n
OC (section) (lot n mber) (grave number)
O Name of Sexton or Person Charge of remises r`3 nnn'
Z (ple se print)
W
Signature Title attaki
(over)
DOH-1555(02/2004)