Prall, Heidi Jude -�I'� - 4 tc7
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Heidi Jude Prall Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/21/1970 1 day War or Dates NA
Place of Death Hospital.Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death ❑X Natural Cause Accident El Homicide 0 Suicide Ei Undetermined 0 Pending
W Circumstances Investigation
U W Medical Certifier Name Title
O Dr.H A Bartholomew,MD
Address
Glens Falls,NY
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 564
ElBurial Date Cemetery,Crematory or Facility Name
Entombment Address
ElCremation
0 Donation
Date Place Removed
ZO 71 Removal and/or Held
— and/or
N
Hold Address
Q0. Date Point of
Cl) L j Transportation Shipment
O by Common
Carrier Destination
Date Cemetery Address
El Disinterment 1/217 Z t Joseph C.Prall Farm Plot,Wevertown,T/O Johnsburg,NY
Date / ( Cemetery Address
QReinterment /6/Z f Pine View Crematory,Queensbury,NY
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 0037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
i- Remains are Shipped,If Other than Above
2 Address
CC
W
a" Permission is hereby granted to dispose of the human remains escribed above a2 ( _
'ndiicated.
Date Issued a istrar of Vital Statistics -044- ( _
t,...
g /
�Q (signature)
District Number 5(055' Place —1-6(A)h OS- "SOkA145tQU(�
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition S?I I�.(l.� Place of Disposition ( `t� 4 r>~._
2 address)
NCC (section) ( 1,:,(lot
`umber) (grave number)
Name of Sexton or Person in Charge of P emises n„n��i
0 ( ase print/
W Signature Title V 11117(
DOH-1555(07/18)p 1 of 2
-
Public Health Law Sec. 4145(2b) 0'''-'
Receipt
IHuman remains of t 4 delivered on_ , 20
1
1
1 Pine View Cemetery Representing the funeral home named,on burial permit
Official Funeral Directors Reg.or License#