Ball, Rose Marie NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Rose Marie Ball Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/29/2023 62 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Minerva Town Street Address 665 14th Road,Minerva Town,New York 12851
pManner of Death El Natural Cause Accident Homicide OSuicide FlUndetermined 7 Pending
W Circumstances Investigation
W Medical Certifier Name Title
Kate Sauer-Jones PA
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Minerva District Number Register Number
City,Town or Village 1557 3
Burial Date Cemetery,Crematory or Facility Name
02/02/2023 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
OZ❑Removal Date Place Removed
and/or and/or Held
Hold Address
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O. Date Point of
Cl) Transportation Shipment
p by Common
Carrier Destination
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Disinterment
Date Cemetery Address
DReinterment 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
F Remains are Shipped,If Other than Above
5 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/01/2023 Registrar of Vital Statistics Theresa Tisk(ECectronicaffy Signed)
(signature)
District Number 1557 Place Town Of Minerva
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Zia,—
Z Date of Disposition 212 I z3 Place of Disposition A(L
2 (address)
W
CC N (section) j (lotnum (grave number/
SName of Sexton or Person in Cha e of Premises
Z ( ease print)
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