Cayer, Sarah - I, # 3L
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Sarah Pauline Cayer Female
Date of Death Age If Veteran of U.S. Armed Forces,
June 29,2013 81 War or Dates
I_ Place of Death Hospital, lnstitutior tirondack Tri-County Health Care
`Z City, Town or Village Johnsburg Street Address Center
'p Manner of Death I X]Natural Cause Accident ' 'Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
0
Address
HHHN,Johnsburg,NY 12843
Death Certificate Filed District Number Register Number
City, Town or Village Johnsburg,NY - 5655
❑Burial Date Cemetery or Crematory
iii
Entombment July 1,2013 Pine View Crematory
Address
ii Cremation 21 Quaker Rd..,Queensbury,NY 12804
Date Place Removed
Z I I Removal and/or Held
and/or Address
H Hold
N
a Date Point of
u) 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
1- Remains are Shipped, If Other than Above
2 Address
lY
W
a Permission is hereby granted to dispose of the human r 'ns described a ve as in i d.
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Date Issued 7-1-13 Registrar of Vital Statistics
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:
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Date of Disposition 1(1(( Place of Disposition ,�'io
Ili (address)
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Ct
0 (section) (lot tuber) (grave number)
p Name of Sexton or Person in Charge of Premises r)I t,,,,,1—
tZ (Please pn )
Signature4 Title Ca 1L
(over)
DOH-1555(02/2004)