Dupuis, Stephanie NEW YORK STATE DEPARTMENT OF HEALTH it
Vital Records Section Burial - Transit Permit
) Name First Middle Last Sex
Stephanie R. Dupuis Female
;- Date of Death Age If Veteran of U.S. Armed Forces,
January 5,2017 48 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 Accident i l Homicide 1 I Suicide Undetermined Pending
Circumstances Investigation
t Medical Certifier Name Title
Eric Pillemer
Address
" CR Wood Cancer Center,Glens Falls,NY 12801
: Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 f
❑Burial Date Cemetery or Crematory
Entombment Address
6,2017 Pine View Crematory
Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z I I Removal and/or Held
and/or Address
H Hold
co
0 Date Point of
O.
Transportation Shipment
a by Common Destination
Carrier
n Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
p Permit Issued to Registration Number
i ::; Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
s; 3809 Main Street,Warrensburg,NY 12885
°,:a: Name of Funeral Firm Making Disposition or to Whom
iAT Remains are Shipped, If Other than Above
Address
o„:1 Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 1 i 6 / 20 ( 7 Registrar of Vital Statistics `, D Y`sL VU
(signature/^ )'J
District Number 560 / Place 6 ( . 5 C� t \ S 7
j
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tuDate of Disposition I / 1 //7 Place of Disposition .Pn,(),,�/ C gory,,,
W (address)
Cl)
CL
(section) ///(lot numbe{��` (grave number)
Q Name of Sexton or Person in Charge of Premises /4r Jt,•�lit
Z � (p?ase print)
/7R �;
W Signature (�.{ ..4 Title 1 R-/V ,
(over)
DOH-1555 (02/2004)