Torraca, Christa Lc S—
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section ....• s Burial - Transit Permit
Name First Middle Last Sex
Christa Torraca Female
Date of Death Age If Veteran of U.S.Armed Forces,
I. September 8, 2006 58 War or Dates
Z Place of Death Hospital, Institution or
W City,Town,or Village Glens Falls Street Address Glens Falls Hospital
G Manner of Death 0 Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑ Pending
W Circumstances Investigation
U Medical Certifier Name Title
W Dr. Robert Sponzo Dr.
0 Address
102 Park St. , Glens Falls, NY 12801
Death Certificate Filed District Number L Q J Register N}irpb�r, a
City,Town or Village Glens Falls 17 �-i '
❑Burial Date Cemetery or Crematory
September 12, 2006 Pine View Crematory
❑Entombment Address
Z 0Cremation Quaker Road Queensbury, NY 12804
Date Place Removed
0 E Removal and/or Held
- and/or Address
h Hold
ii Date Point of
0 ❑Transportation Shipment
d by Common Destination
i Carrier
Date Cemetery Address
o ❑Disinterment
❑Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home 01142
Address
82 Broadway, Fort Edward, New York 12828
~ Name of Funeral Firm Making Disposition or to Whom
2 Remains are Shipped, If Other than Above
it
W Address
II
Permission is hereby granted to dispose of the human remains describe 23:ii artdica
Date Issued q i1/ / Registrar of Vital Statistics
r1
(signature)
District Number 5 6 0 ( 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
luDate of Disposition 09/12/2006 Place of Disposition Pine View Crematory
2 (address)
t,
1 (section) ,, lot number) (grave number)
Name of Sexton or Person in Charge of Premises ( INC , r,z It
Z (please print)
W a
Signature /1k(....s Title C%e n,,;t o r
(over)
DOH-1555 (02/2004)