Bederian, Janice f
NEW YORK STATE DEPARTMENT OF HEALTH _
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Janice M. Bederian Female
Date of Death Age If Veteran of U.S. Armed Forces,
November 15,2013 55 War or Dates
°h Place of Death Hospital, Institution or
Z City, Town or Village Warrensburg Street Address 1 Monte Vista Dr.
▪ Manner of Death I XI Natural Cause [ I Accident I I Homicide Suicide I I Undetermined Pending
Circumstances Investigation
o Medical Certifier Name Title
Paul Bachman
Address
MUM,Warrensburg,NY 12885
Death Certificate Filed District Number Register Number j n
, City, Town or Village Warrensburg 5660 y
❑Burial Date Cemetery or Crematory
II
Entombment November 18,2013 Pine View Crematory
Address
®Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z I !Removal and/or Held
O and/or Address
H Hold
N
0 Date Point of
u) Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
n 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
▪I Remains are Shipped, If Other than Above
E. Address
ll
Permission is hereb/'l granted to dispose of the human remain described a ve as indica
Date Issued /�// /3 Registrar of Vital Statistics £> Ind2 L,.
(signature) / ...y_evi
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 11-70-i3 Place of Disposition ZU y Cr:e,..- i .,__
W (address)
co
ce (section) (lot number)
Q Name of Sexton or Person i Charge of Premises dr.,-. 6, S (grave number)
L,it+
'Z (ple se print)
Signature L Title OLE misalL
i
(over)
DOH-1555 (02/2004)