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Ehle, Rose M.
f l U NEWYORKSTATEDEPARTMENTOFHEALTH t Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Rose M.Ehle Female Date of Death Age If Veteran of U.S.Armed Forces, 12/30/2020 79 Years War or Dates I-, Place of Death Hospital,Institution or Z City,Town or Village Warrensburg Town Street Address 34 Grandview Lane,Warrensburg Town, New York 12885 W Manner of Death © W Natural Cause El Accident Homicide Suicide Undetermined EI Pending U Circumstances Investigation Q Medical Certifier Name Title Suzanne Bergin DO Address 9 Carey Road,Queensbury Town, New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Warrensburg 5660 30 Burial Date Cemetery,Crematory or Facility Name 01/04/2021 Pine View Crematory ❑Entombment Address lCremation Queensbury Town,New York ❑Donation o ElRemoval Date Place Removed and/or and/or Held Hold Address 0 CL Date Point of N ❑Transportation p by Common Shipment Carrier Destination 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 St,Warrensburg, New York 12885 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 5 Address LU a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/31/2020 Registrar of Vital Statistics Pamela MGCoyd ECectronicaCCySigned) (signature) District Number 5660 Place Warrensburg, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition IZ I Place of Disposition n„ 2 (address) W CC N (section) (lot number) (grave number) SOrn/it of Sexton or Person in Charge of Pre ' es t ,Y1�. Jwnl Ct 1// (pie e print) 7 lL Signature C Title C r'/l � D"'r g "-Q DOH-1555 07/18)p id 2 t , Public Health Law Sec. 4145(2b) Q 1431 2 Receipt 1 1 Human remains of delivered on / ! , 20 - I r Pine View Cemetery Representing"the funeral home named on burial permit Official Funeral Directors Reg.or License# a`