Armstrong, Gertrude B. NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Gertrude B.Armstrong Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/30/2021 74 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death Pending
Natural Cause Accident Homicide Suicide Undetermined
Circumstances Investigation
Medical Certifier Name Title
Asim Chaudry MD
Address
100 Park St,Glens Falls, New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 318
❑Burial Date Cemetery,Crematory or Facility Name
08/03/2021 Pine View Crematory
Entombment Address
lCremation Queensbury Town,New York
❑Donation
Removal Date Place Removed
and/or and/or Held
HN Hold Address
O
Ct. Date Point of
❑Transportation Shipment
by Common
Carrier Destination
0 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
Remains are Shipped,If Other than Above
5" Address
CC
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/02/2021 Registrar of Vital Statistics Men Andrew Curtis(EfectronicalTy Signed)
(signature)
District Number 5601 Place Glens Falls, 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 Y 13 u Z) Place of Disposition
2 (address)
W
CC CC (section) (tot number) (grave number)
8 Name of Sexton or Person in Charge of remises `° t4`1.
(p14 e print)
z ra
W Signature Title
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# rr