Dulmer, Laura NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Laura E. Dulmer
Date of Death Age If Veteran of U.S. Armed Forces,
11-18-97 83 War or Dates NA
Place of Death Hospital, Institution or
City, Town or Village ueensb Street Address
Manner of Death 0 Natural Cause Accident Homicide 0 Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Dr. Spitzer MFD
Address
Glens Falls,NY
Death Certificate Filed District Number Re ter Number
City, Town or Village Queensbury 5657
Date Cemetery or Crematory
❑Burial 11-19-97 Pine View Crematory
0 Cremation Address Queensbury, NY
Date Place Removed
0❑Removal and/or Held
-• and/or Address
Hold
Q Date Point of
[]Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker FH 00018
Address
Warrensburcf, NY
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 huma ains described above as indicated.
Date Issued 11-19-97 Registrar of Vital Statistics
(signature)
5657 Place T/0 Queensbury, NY
District Number
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition//f r Place of Disposition
(address)
iJJ
(section) (lot number) (grave number)
D Name of Sexto or Person in Charge of Pre ises, �7[,,f��(�(J Z/A
z (please print) r
Signature Title ,s
DOH-1555 (10/89) p. 1 of 2 VS-61