Babbitt, Jane IT 130
NEW YORK STATE DEPARTMENT OF HEALTH I -Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Jane Alice Babbitt Female
Date of Death Age If Veteran of U.S. Armed Forces,
March 3, 2012 90 War or Dates
i Place of Death Hospital, Institution or
Z City, Town or Village Argyle Street Address Pleasant Valley Infirmary
Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
0
Address
Death Certificate Filed District Number�� Register Number
City, Town or Village Argyle,NY 13
❑Burial Date Cemetery or Crematory
❑Entombment March 6, 2012 Pine View Crematorium
Address
❑x Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
N
O Date Point of
NTransportation Shipment
a by Common Destination
Carrier
IDisinterment Date Cemetery Address
IReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Sullivan-Minahan& Potter 01646
Address
407 Bay Road,Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
i Remains are Shipped, If Other than Above
Address
OG
t13
Permission is her by granted to dispose of the human remains described above as indicated.
�
Date Issued Registrar of Vital Statistics &JIB 11;C-tn.itt
n (signature)
District Number 5 f' Place Argyle,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 3-' -,3a1L Place of Disposition y 2 d;ew Cr'em43 01', H'►
(address)
W
co
re (secs (lot number) (grave number)
Op Name of Sexton or Person in Charge of Premises I, y,,�0-4 kr�r►e l�C
(please print
W Signature Title Cr e w.-4-�dt-�� IIS�
(over)
DOH-1555(02/2004)