Cole, Kathryn •A s
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
' • Name First Middle Last Sex
Kathryn G. Cole Female
Date of Death Age If Veteran of U.S. Armed Forces,
February 13,2017 58 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address 34 Haviland Avenue
�,,,. Manner of Death ! Natural Cause n Accident n Homicide n Suicide Undetermined n Pending
Circumstances Investigation
Medical Certifier Name Title
Timothy Murphy
Address
52 Haviland Ave.,Glens Falls,NY 12801
Death Certificate Filed District Number Registe N er
City, Town or Village Glens Falls 5601
LAI Burial Date Cemetery or Crematory
1-1 February 16,2017 Pine View Cemetery
❑Entombment Address
❑Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z fl Removal and/or Held
and/or Address
1_- Hold
M
O Date Point of
a.
n Transportation Shipment
p by Common Destination
Carrier
n Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
f Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
A• ddress
53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
f Address
P• ermission is hereby granted to dispose of the human r ains described a ove as ndica -d.
Date Issued () /5�/'7 Registrar of Vital Statistics t �'$,„..r
ignature)
.r
D• istrict Number 5601 Place Glens Falls
I-, I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tuDate of Disposition 2/1 6/1 7 Place of Disposition Pine View CPmPtPryd, Queensbury, NY
W
Erie 1T 1
(section) (lot number) (grave number)
o• Name of Sexton or Person in Charge of Prem' s Connie L. Goedert
Z d (please print)
W Signature 7 /Lita#, -e-e Title Cemetery Superintendent
(over)
DOH-1555(02/2004)