Bauer, Evelyn NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last i Sex
Evelyn V. Bauer Female
Date of Death Age If Veteran of U.S. Armed Forces,
Feb. 19, 1998 81 War or Dates No
Place of Death Hospital, Institution or
City, TgP9qP% Glens Falls Street Address Glens Falls Hospital
Manner of Death Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Addres
Death Certificate Filed District Number Register Number
City, 3PQ � Glens Falls 5601 )p
Date Feb. 25, 1998 Cemetery or Crematory
❑Burial Pine View Cremator
Address Queensbury, N.Y 12804
remation
Date Place Removed
8❑Removal and/or Held
•.• and/or Address
Hold
Q Date Point of
Q Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Adirondack Cremation Associates 00016
Address 114 Main St, Warrensburg, N.Y. 12885
<> Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
AX
Permission is hereby granted to dispose of the human remains described aboy as ' at
G
Date Issued Registrar of Vital Statistics
(signature)
District Number
5601 Place
Falls City Clerk's Office, Glens Falls, N.Y. 12801
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
f- �/ � /�
Date of Disposition97
Place of Disposition Pf /�' /�:= l/�� C/, Gi— A
(address)
LIJ
</J
M (section) ^`^ nu ber} (grave number)
GName of Sexton or Person in Charge of Pre isesC/Ue �—
z (please print) y�
Signature Title
DOH-1555 (10/89) p. 1 of 2 VS-61