Whitbeck, Shirley NEW YORK STATE DEPARTMENT OF HEALTH * 59
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Shirley I J. Whitbeck Female
Date of Death Age If Veteran of U.S. Armed Forces,
January 26,2013 81 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Warrensburg Street Address 233 River Street
p Manner of Death I Xi Natural Cause Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
0 Nancy Carney MD
Address
HIIFIN,Wrg.,NY 12885
Death Certificate Filed District Number Register Number
City, Town or Village T/O Warrensburg,NY 5660 5
❑Burial Date Cemetery or Crematory
❑Entombment January 28,2013 Pine View Crematory
Address
I Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
O and/or Address
H Hold
tI)—
O Date Point of
NTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date 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
I- Remains are Shipped, If Other than Above
2 Address
W
W
O.
Permission is hereby granted to dispose of the humairtema describe above as indicated.
Date Issued 1-28-13 Registrar of Vital Startics ,./t-X./ L
.- (signature)
District Number 5660 Place T/O Warrensburg,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z �^' S.
W Date of Disposition I-t9-13 Place of Disposition gill,WI C r-.douN.,
W (address)
co
O (section) <(lot number) (grave number)
pName of Sexton or Person in Charge of Premises AIL. �lm•Ift.
Z ease print)
W
Signature /411._ Title eaat,M Pera
(over)
DOH-1555 (02/2004)