Gecewicz, Rose NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
=a Name First Middle Last Sex
Rose C. Gecewicz Female
i 3 Date of Death Age If Veteran of U.S. Armed Forces,
October 26,2018 93 War or Dates
`4_ Place of Death
Hospital, Institution or
°2 City, Town or Village Warrensburg Street Address Countryside Adult Home
iManner of Death ! I Natural Cause Accident I I Homicide Suicide Undetermined Pending
L - Circumstances Investigation
w Medical Certifier Name Title
C] Bryan Smead
Address
Bolton Health Center,Bolton Landing,NY 12814
r Death Certificate Filed District Number Register Number
City, Town or Village Warrensburg 5660
❑Burial Date Cemetery or Crematory
❑Entombment October 29, 2018 Pine View Crematory
Address
1 Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
OZ I !Removal and/or Held
and/or Address
H Hold
co
0 Date Point of
0 I 'Transportation Shipment
a by Common Destination
Carrier
I
Disinterment Date Cemetery Address
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
Remains are Shipped, If Other than Above
2s Address
11:
0.
Permission is hereby granted to dispose of the hum ains de ribed above as indicated.
Date Issued DAv Registrar of Vital Static • (43/7417.<-1
(signature)
District Number 5660 Place Warrensburg,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ILI Date of Disposition 1b'3j/0" Place of Disposition t,tiV►1,-, e '
LL1 (address)
CO
re
O (section) (lot number) (n k, 31... number)
p Name of Sexton or Person in Charge of Premises
tu
Z (please print)
Signature Title arkaivilitt
(over)
DOH-1555 (02/2004)