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De Crescente, Constance 4 . 1533 NEW YORK STATE DEPARTMENT OF HL LTH Vital Records Section Burial - Transit Permit •i.'} Name First Middle Last Sex iM Constance Anne De Crescente Female , Date of Death Age If Veteran of U.S. Armed Forces, s July 6, 2017 61 War or Dates Place of Death Hospital, Institution or Z City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death j Natural Cause Accident Homicide Suicide Undetermined Pending Of Circumstances Investigation Medical Certifier Name Title James North MD Address Fi 100 Broad Street Glens Falls,New York `' Death Certificate Filed District Number Register Nu b as City, Town or Village Glens Falls 5601 L$7/ ❑Burial Date Cemetery or Crematory July 11, 2017 Pine View Crematorium ❑Entombment Address ❑x Cremation 51 Quaker Road, Queensbury,NY 12804 Date Place Removed ZZ ❑Removal and/or Held and/or Address E Hold N 0 Date Point of N ❑Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address W. Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 ;.f Address 'I' 53 Quaker Road, Queensbury, NY 12804 ai Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address `<+ Permission is hereby ranted to dispose of the human remains e cribeddgbov jiidicated. >< Date Issued ©7 /i 200 Registrar of Vital Statistics 2 ' . (signature) r gf District Number 5601 Place Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Lii Date of Disposition 7 J1l i 0 Place of Disposition 914‘Yv enw.cr{'-., W (address) co 0 (section) //f (lot number) (grave number) Q Name of S ton or Person in Charge of Premises 14rr �L;44 2Z (Wiese print) Signature F k Title 11 (over) DOH-1555(02/2004)