Curry, Katherine A
NEW YORK STATE DEPARTMENT OF HEALTH 4 4x Z1O
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Katherine R. Curry Female
Date of Death Age If Veteran of U.S. Armed Forces,
April 09, 2017 83 yrs . War or Dates no
Place of Death Hospital, Institution or
Ill City, Town or Village Fort Ann Street Address 1045 Co. Rte. 16
p Manner of Death❑x Natural Cause ['Accident 0 Homicide ❑Suicide ❑Undetermined Pending
lU Circumstances Investigation
W Medical Certifier Name Title
Kevin Gallagher MD.
Address
79 North St. , Granville, NY. 12832
Death Certificate Filed District Number Register Number
City, Town or Village Fort Ann 5754
i!!i OBurial Date Cemetery or Crematory
QEntombment April 10, 2017 PineView Crematorium
Address
cremation Queensbury, NY. 12804
Date Place Removed
Q❑Removal and/or Held
and/or Address
I:: Hold
10
0 Date Point of
ti Q Transportation Shipment
a by Common Destination
Carrier
Q Disinterment Date Cemetery Address
< Q Reinterment Date . Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Mason Funeral Home 01117
Address
18 George St. , PO. Box 277, Fort Ann, NY. 12827
Name of Funeral Firm Making Disposition or to Whom
1- Remains are Shipped, If Other than Above
Z Address
tr
LU
d` Permission is hereby granted to dispose of the human re ins described abo� s' icated.
Date Issued 4/10/1 7 Registrar of Vital Statistics -�
(signature)
District Number 5/73 Placeaf,It /�
11
l�L�
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
k
LU Date of Disposition 11111111 Place of Disposition F ikwv ehnaIi to_
(address)
ta
CC (section) 0 i(lot number) (grave number)
Name of Sexton or Person in Charge of Premises (4, kAir
2 ( I ase print)
i-1
Signature r� ' Title (AAn Fit
(over)
DOH-1555 (02/2004)