Morrison, Frances itsg3
NEW YORK STATE DEPARTMENT OF HEALTH t
Vital Records Section • Burial - Transit Permit
Name First Middle Last Sex
Frances E. Morrison Female
Date of Death Age If Veteran of U.S. Armed Forces,
September 28,2013 54 War or Dates
I'- Place of Death Hospital, Institution or
Z City, Town or Village Saratoga Springs Street Address Saratoga Hospital& Nursing Home
p Manner of Death X Natural Cause I 'Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
Catherine Dawson MD
Address
21 Church St.,Saratoga Springs,NY 12866
Death Certificate Filed District Number Re iste,�Number
City, Town or Village City of Saratoga Springs 4501 (�' 1`--�
❑Burial Date Cemetery or Crematory
Entombment Address
1,2013 Pine View Crematory
Address
Ex Cremation 21 Quaker Rd.,Queensbury,NY 12804
Date Place Removed
Z I 'Removal and/or Held
and/or Address
H Hold
N
O Date Point of
U) I 1 Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
(Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
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
IY
W
O.
Permission is hereby granted to dispose of the human rema' ri d of as indicated.
Date Issued 9-30-13 Registrar of Vital Statistics
(signature)
District Number 4501 Place City of Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition t014/13 Place of Disposition ogwORv �wwefofa.
2 (address)
N
0 (section) (lot number) . (grave number)
Op Name of Sexton or Person in Charge of Pre ises AA SK,
I11 Z lease print)
Signature �Q..__ Title C11tinitto0-
(over)
DOH-1555(02/2004)