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Rozell, Areatha A
y , -)0 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Areatha A.Rozell Female Date of Death Age If Veteran of U.S.Armed Forces, 01/18/2022 42 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ©Natural Cause Ei Accident 0 Homicide 1=1 Suicide ❑Undetermined El Pending ILI 0 Circumstances Investigation WW Medical Certifier Name Title CI Marvin Davidowitz MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 51 ElBurial Date Cemetery,Crematory or Facility Name 01/21/2022 Pine View Crematory El Entombment Address X❑Cremation Queensbury Town,New York ElDonation Z Date Place Removed 0 ❑Removal and/or Held H and/or N Hold Address 0 N ❑Transportation Date Point of 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 H Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/21/2022 Registrar of Vital Statistics MeganWoCin(ECzctronicallySigned) (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 W Date of Disposition `2,?-_?od,� Place of Disposition 63:,.,)e_ U':e..,;, L 9/".�,t ,/- , 2 (address) W Ill (section) (lot number) (grave number) SName of Sexton or Person in Cha of Premise 1\w(.7ind 4) L—) 1��cL Z / � /please print) W Signature lie l/ d', Title 0 r�ti'�� ``tJ— DOH-1555(07/18)p 1 of 2 a r 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#