Towers, Jean FROM :TOWN OF MINDEN
FAX N0. :5189933258 Jan. 07 2013 05:31PM P1
FROM : AL,EXANDER FUNERAL HOMES PHONE NO, : 5186232065 Jan. 07 2013 12:44PM P1 / /
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last {Sex
—
Jeaa Ann ... Towers ....,. __.,1..,_.-.H rnte<.lc _,.__,
Date of Death If Veteran Cf U.S.Armed Forces,
Jstnaary__2,2013 ..,�. 78 War or Dates NA
Place of Death _. ...__
Hospital,Institution or .,_ ,,,
le City,Town or Village: Fort Plain Street Address 29 Lydian Street
Er
Manner of Death{]Natural Cause 0 Atctdent 0 Homiotde El Suicide Q Undetermined ❑Pending
Circumstances Investigation
Medical Certinier Name Title _.
,,�,.. Dr,Peter Ltieber� �. _...x ,,. _ ._
,,, Addret4
,....4. - Cris Blvd.,C,ete-jharte1 NV �.,.. _
Death Glrtiticate Flied Dlattist Number Register Number
City,Town or Village Ft.elide NY 2824 2
❑Burial Date Cemetery or Crematory -- .
January 8t2013 .. Pia/View Crematory . . --...._
Address
iCremation _ 21, gsLte:r Qaeeiuib�,NY 12804
Date _ ' Piece R '
Z LI Removal andlor Held
andlor
Hold
F
• Address _._
Q . Date -..•.- I Paint - ..._ ...... .,,�-- -._�._...._... ._.._..,__
tTransportation Shipment
0 by Common Destination
Carrier
0 DisintermentDate Cemetery Address .__ ._�..,......__.. _
•
0 Reinterment....,.. Cemetery Address__..._. _, .,_
�*;7.4 Issued to Regietreden Number
g Name of Funeral Home Aleseede-Bskerr Funeral Some 00035
w" Address -,* ..,, _..
` 3809.We Street,Warrensburg,NV 12885 . .
• 2s Name of Funeral Firm Making Disposition or to Whom
'.. Remains are Shipped, If Other than Above
Address „. _ .�_
, r
Permission is e y O ute:d to dispose of the human remains described above as istdloated.
i, Date Issued / 7 ao� IZegiettrsr of Vital Statistics •
lax.; .,.. _
: 4 Disae t Number 2824 Place
•
r• I certify that the remains of the decedent identified above were(Reposed of in accordance with this permit on:
11. Date of Dispo iiion I-ti-t3 Place of Disposition - _ u..� (address:
. ("`sc+ctian) "� Pot „ne ww) rnb60 ,
Z Name of Sexton or Person in Chards Premises rArrl _ ,4 (gale rl+
•
Im_Signature I--- , ',Trite I rAirl,L
(ovary
DOH-1565(42@004) .