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Aldrich, Gretchen E 101 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Gretchen E.Aldrich Female Date of Death Age If Veteran of U.S.Armed Forces, 11/27/2021 87 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Hadley Town Street Address 34 Park Avenue, Hadley Town, New York 12835 p Manner of Death ©Natural Cause 1=1 Accident ❑Homicide Suicide ❑Undetermined ❑Pending W V Circumstances Investigation W 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 Hadley 4558 24 ❑Burial Date Cemetery,Crematory or Facility Name 11/29/2021 Pine View Crematory ❑Entombment Address O Cremation Hadley Town, New York ❑Donation Removal Date Place Removed and/or and/or Held Hold Address In 0. Date Point of • []Transportation CI by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address Date Cemetery Address ❑Reinterment Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500, Lake Luzerne, New York 12846 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above 2 Address CC W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/29/2021 Registrar of Vital Statistics PaldineG9rr i(Elafrcridly9ge4 (signature) District Number 4558 Place Hadley, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IF- WDate of Disposition /2-/2 i / Place of Disposition F .4,‘,0 C rem4 2 (address) W NCC (section) (lot numb ) (grave number) a 0 Name of Sexton or Person in Char e of Premissplease Z p/ease print) W Signature Title t9e42144.0� DOH-1555(07/18)p 1 of 2 1 s Public Health Law Sec. 4145(2b) 0 1 3 7 8 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#