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Parent, Alice H
NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Alice H.Parent Female Date of Death Age If Veteran of U.S.Armed Forces, 11/16/2023 96 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Johnsburg Town Street Address Elderwood at North Creek W Manner of Death Undetermined Pending 111 El Natural Cause Accident Homicide Suicide Circumstances Investigation W Medical Certifier Name Title O Jennifer Donovan DO Address 112 Ski Bowl Rd,Johnsburg Town, New York 12853 Death Certificate Filed Town Of Johnsburg District Number Register Number City,Town or Village 5655 43 Burial Date Cemetery,Crematory or Facility Name 11/20/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation ZZ❑Removal Date Place Removed and/or and/or Held N~ Hold Address 0 Date Point of U) Transportation Shipment Q by Common Carrier Destination LI 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 1— Remains are Shipped,If Other than Above 5 Address W 0- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/20/2023 Registrar of Vital Statistics jean M Con stock(ECectronically Signed) (signature) District Number 5655 Place Town Of Johnsburg I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition //eizpz3_ Place of Disposition ?itnJ C (f�eve Can IiJ (address) W CC (section) (lot n tuber) (grave number) Q g Name of Sexton or Person in Charge f Premi s Il ��J�O� Mc] (please print) W Signature `i % Title We'-440c- DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt 1 Human remains of delivered on , 20 I Pine View Cemetery Representing the funeral home named on burial,permit Official Funeral Directors Reg.or License#