Berretta, Rose e '0 C(
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Rose M. Berretta Female
Date of Death Age If Veteran of U.S. Armed Forces,
March 1,2013 88 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address The Pines At Glens Falls
Q Manner of Death g Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
G Gerard Abess Dr.
Address
IIIHIN,9 Carey Rd.,Queensbury,NY 12804
Death Certificate Filed District Number Register N p ber
City, Town or Village Glens Falls 5601 r�
D Burial Date Cemetery or Crematory
❑Entombment March 4,2013 I Pine View Crematory
Address
xi Cremation Quaker Rd.,Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
O Date Point of
a v7 Transportation Shipment
a 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
F Remains are Shipped, If Other than Above
2 Address
CZ
a
Permission is hereb granted to dispose of the human r sins escribed bove as i ed.
Date Issued p , Registrar of Vital Statistics 1 / /
(signature)
District Number 5601 Place Glens Falls //6 / /
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
MI Date of Disposition 'Vc-I3 Place of Disposition ,,��^Z,, a..1 Cry ie s mew
(address)
W
N
(section) (lot numbe (grave number)
pName of Sexton or Person in Charge f Premises t,,i ..
Z hh (please print)
Signature Title Caeotr()V,
(over)
DOH-1555 (02/2004)