Cody, Ethel ' 4 'a. # 7
NEW YORK STATE DEPARTMENT OF HEALi Burial - Transit Permit
Vital Records Section '
f'< Name First Middle Last Sex
Ethel Mae Cody Female
F Date of Death Age If Veteran of U.S. Armed Forces,
`tf April 5, 2017 84 War or Dates n/a
f�rr
'',v Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Wesley Health Care Center
Manner of Death X Natural Cause n Accident Homicide n Suicide Undetermined Pending
—Circumstances Investigation
l Medical Cejoitilter, Name Title
X<,,
.� Address
A>-f= r& `\NHS i
`f , Death Certificate Filed ` District Number Register Number
City, Town or Village�..,,,, 9 Saratoga, NY 14601
El Burial Date Cemetery or Crematory
April 7, 2017 Pine View Crematorium
❑Entombment Address
®Cremation 51 Quaker Road, Queensbury, NY 12804
Date Place Removed
Z ❑Removal and/or Held
and/or Address
H Hold
CO
0 Date Point of
N ❑Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
:,a
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
&* Address
f
53 Quaker Road, Queensbury,NY 12804
t Name of Funeral Firm Making Disposition or to Whom
4 Remains are Shipped, If Other than Above
. Address
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Permission is h re y granted to dispose of the human rema' c1.L1a e indicat
Date Issued Registrar of Vital Statistics •
(signature)
'f District Number L1501 Place Spflr\cjS .
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
Z
Lti Date of Disposition Lj'f l'n Place of Disposition gi i rr�rn .' orio„=
(address)
W
CO
!Y (section) / (lot number (grave number)
pName of Sexton or Person in Charge of Premises ��r.� �t,� t��,tr
Z (pase print)
W
Signature Title 6404 AL
(over)
DOH-1555(02/2004)