Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Walter, Delila R.
if SS I NEW YORK STATE DEPARTMENT OF HEALTH - ' - Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Delila R.Walter Female Date of Death Age If Veteran of U.S.Armed Forces, 07/12/2021 106 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing W Manner of Death Undetermined Pending © Natural Cause ❑Accident ❑Homicide 0 Suicide W Circumstances Investigation W Medical Certifier Name Title G Roslyn Socolof MD Address 42 Gurney Ln,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 145 0 Burial Date Cemetery,Crematory or Facility Name 07/16/2021 Pine View Crematory ❑Entombment Address ElCremation Queensbury Town,New York ❑Donation Z ❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 Date Point of N Transportation Shipment Q by Common Carrier Destination 0 Disinterment Date Cemetery Address Ei 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 % Address M W Q. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/15/2021 Registrar of Vital Statistics Caroline 7-Ci12Cegarde Barber(ECectronicaify Signed) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: t' A)W Date of Disposition 1 i)le 1 l,( Place of Disposition addrjt,c ut.-- ess) Ir (section) (lot number) (grave number) S SName of Sexton or Person in Charge of Prem' es Arl) �,,,�,t if (p/easy print) rn,� W C � Title t �6�1 Signature DOH-1555(o7/18)p 1 of 2 I Public Health Law Sec. 4145(2b) 1 Receipt 1 IHuman remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# ' 1