Decker, Helen It 3 a
NEW YORK STATE DEPARTMENT OF HEALTH t s
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Helen M. Decker Female
Date of Death Age If Veteran of U.S. Armed Forces,
June 2, 2013 85 War or Dates
)... Place of Death Hospital, Institution or
Z City, Town or Village Warrensburg Street Address 10 Ashe Drive
`p Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
Ci Paul Bachman Dr.
Address
HHHN,Warrensburg,NY 12885
Death Certificate Filed District Number Register Number /3
City, Town or Village Warrensburg 5660
❑Burial Date Cemetery or Crematory
June 4,2013 Pine View Crematory
Address
®Cremation Quaker Rd.,Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
O and/or Address
F' 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 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
Address
Ce
Permission is hereby granted to dispose of the human re a' described bove as indicated.
Date Issued c7/ 43 Registrar of Vital Statistics • a/
4a4
i nature
District Number 5660 Place Warrensburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition b15113 Place of Disposition ei�L►cfal'sv....-
L (address)
W
re (section) C (lot'lumber) (grave number)
O Name of Sexton or Person in hargeF ,x,�of Prem• es e .,
fi-
Z (pi ase print)
w
Signature �I Title CI OROI—
(over)
DOH-1555 (02/2004)