Foos, Deborah 11-
NEW YORK STATE DEPARTMENT OF HEALTH .: ► 3ci
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Deborah L. Foos Female
Date of Death Age If Veteran of U.S. Armed Forces,
July 14,2013 55 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Johnsburg Street Address 10 Milton Avenue,North Creek
p Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical rtifier Na a Title
0 3nu.sM9 0{0/M MD
Aess
NY
Death Certificate Filed MUM, � ��� District Number Register Number
City, Town or Village Johnsburg,NY 5655 02 I
❑Burial Date Cemetery or Crematory
Entombment July 16,2013 Pine View Crematory
Address
❑x Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
N
O Date Point of
NI I Transportation 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 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped, If Other than Above
2 Address
a
Permission is hereby granted to dispose of the human remai s describ a as indicated.
Date Issued !- /S'/3 Registrar of Vital Statistics / +CCU
(signature)
District Number 5655 Place Johnsburg,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition 1- 0-t3 Place of Disposition ..ettU erterici0f
W (address)
Ct
(section) (lot number) c (grave number)
pName of Sexton or Person in Charge of Premises !be, I'fr Jra!1
Z (plebse print)
Signature L Title Cl7ENl►rdit-
(over)
DOH-1555 (02/2004)