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Hall, Elma --4 z93 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Elma I.Hall Female Date of Death Age If Veteran of U.S. Armed Forces, 04/08/2018 90 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Johnsburg Town Street Address Adirondack Tri-County Nursing And Rehabilitation Center,Inc. Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title James Hindson MD Address 112 Ski Bowl Rd,Johnsburg Town,New York 12853 Ze Death Certificate Filed District Number Register Number City, Town or Village North Creek 5655 11 OBurial Date Cemetery or Crematory 04/10/2018 Pine View Crematory El Entombment Address ®Cremation Queensbury Town, New York Date Place Removed ❑Removal and/or and/or Held Address Hold Date Point of ❑Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address •❑Reinterment Date Cemetery Address Permit Issued to Registration Number RA Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. 1. Date Issued 04/09/2018 Registrar of Vital Statistics zthfeen C.Lorah(ECectronicalTySigned) (signature) District Number 5655 Place North Creek, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition gill I Place of Disposition (address) (section) /]/ (lo number) (grave number) Name of Sexton or Person in Charge of Premises {//4y � ease print) Ssuit Signature -' Title it0.1 (over) DOH-1555 (02/2004)