Allen, Mary k
NEW YORK STATE DEPARTMENT OF HEALTH - {N/
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Mary Elizabeth Allen Female
Date of Death Age If Veteran of U.S. Armed Forces,
08/29/2017 73 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death X❑Natural Cause El Accident Homicide ❑Suicide Undetermined El Pending
Circumstances Investigation
Medical Certifier Name Title
Dean Reali DO
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 463
❑Burial Date Cemetery or Crematory
09/01/2017 Pine View Crematory
❑Entombment Address
®Cremation Queensbury, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/31/2017 Registrar of Vital Statistics wg6ertACurtis 'ElectronicaaySigned-
(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:
Date of Disposition q J' lace of Disposition 'f� 0t-", e�wwc)j o--
(address)
(section) n(lot number) Ss :t
(grave number)
Name of Sexton or Person in Charge of Pre ises e f
(p/e a print)
Signature Title 411)1—
(over)
DOH-1555 (02/2004)