Ostrander, Sara NEW YORK STATE DEPARTMENT OF HEALTH ` LI J 1
Vital Records Section 4 Burial - Transit Permit
Name First Middle Last Sex
Sara. R. Ostrander F
Date of Death Age If Veteran of U.S. Armed Forces,
Oct . 30 , 2006 38 War or Dates No
Ir- Place of Death Hospital, Institution or
Z City, Town or Village City of Glens FallsStreetAddress Glens Falls Hospital
Ili
Manner of Death X❑ Natural Cause ❑Accident ❑Homicide ❑Suicide ri❑ Undetermined ❑Pending
W Circumstances Investigation
tii• Medical Certifier Name Title
G Dr. Haines North rID
Address
100 Broad St . Glens Falls , NY 12801
Death Certificate Filed District Number Register Number
City, Town orVillafeity of Glens Falls l4,0/ .5"y2._
❑Burial Date Cemetery or Crematory
Nov. 6 , 2006 Pine View Crematory
Entombment Address
❑x Cremation Queensbury, NY 12804
Date Place Removed
Z ri❑Removal and/or Held
and/or Address
w= Hold
U)
O Date Point of
EL ri
.0Li Transportation Shipment
0 by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home £1. . Kilmer Funeral Home 01141
Address
136 Main St . South Cl runs P=Ills NY 12803
Name of Funeral Firm Making Disposition or to Whom
• Remains are Shipped, If Other than Above
• Address
#C
if
P' Permission is hereby ranted to dispose of the human remains described above in ' d.
Date Issued A GI/ D 6 Registrar of Vital Statistics .14: 'lyy�
_ (signature)
El District Number �SL'0/ Place o/� �/ /L�y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
k lit Date of Disposition ii /7/cL P
Place of Disposition , .u,t, C 1`vn.^7."f c 0 id.,-
2 (address)
UI
VI
CC (section) (lot number) (grave number)
Ck{`iSnn ►
p Name of Sexton or Per on in Charge of Premises 1
/ I C, (please print)
41 Signature (-�( / `'� Title ' "=��'�
(over)
DOH-1555 (02/2004)