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Andersen, Edna NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Edna M. Andersen F Date of Death Age If Veteran of U.S. Armed Forces, War or Dates Place of Death �R�T®GA SPRINGS Hospital, Institution or City, Town or Village Street Address Saratoga Hospital ,.- Manner of Death©Natural Cause Accident Homicide Suicide Undetermined El Pending Circumstances Investigation Medical Certifier Name Susan Horsey Title MD Address 42 Myrtle St, SAratoga Springs, NY 12866 Death Certificate Fil4WMTOGA SPRINGS District Number of Register u ber 46 City, Town or Village Date Cemetery or Crematory El Burial Dec 14, 1998 Pineview Crematory Address�Cremation Quaker Rd Queensbury, NY 12804 Date Place Removed 0 Removal and/or Held ..• and/or Address }" Hold 0. Q Date Point of N❑Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Tunison Funeral Home Name of Funeral Home 01 898 Address 105 Lake Ave Saratoga Springs, NY 12866 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hrebV'ranted to dispose of the human main escribed a ove a indicated. Date Issued 1 2 1 �' ,Registrar of Vital Statistics €s>. District Number Place SARATOGA SPRINGS I certify that the remains of the decedent identified above were f/disposed of in accordancewith this permit on: W.W. Date of Disposition/0?-� ` Place of Disposition / /1'i� �f�`�✓ e✓���� (address) UJI W cc (section) (lot nu}�b�,&Jgrave number) Name of Sextonin r Person i Charge of Premises _iDD /v !/� please print) �►--� W. Signature G, Title DOH-1555 (10/89) p. 1 of 2 VS-61