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AovWan:Apr 18,=7
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
HARRIET J. FERRARO Female
Date of Death Age If Veteran of U.S. Armed Forces,
August 1, 2007 75 War or Dates
}- Place of Death Hospital, Institution or
WW
City, Town or Village Glens Falls, NY Street Address Glens Falls Hospital
Manner of Death Natural Cause ❑Accident ❑Homicide ❑Suicide Undetermined ❑Pending
Circumstances Investigation
LU Medical Certifier Name Title
Mathew Varughese, MD
Address
Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls, NY 5601
❑Burial Date Cemetery or Crematory
August 3, 2007
Pine View Crematory
❑Entombment Address
[ remation Quaker Rd Queensbu NY 12801
Date Place Removed
❑Removal and/or Held
fl and/or Address
=" Hold
fa
0 Date Point of
t
Transportation Shipment
C3 by Common Destination
Carrier
Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
...,...,-JPermit Issued to Registration Number
Name of Funeral Home Regan & Denny Funeral Home
01482
Address
53 Quaker Rd Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
t
Permission is hereby granted to dispose of the huma a ains scribed altbve as indica d.
Date Issued 8/3/2007 Registrar of Vital Statistics
(signature)
District Number Place ,�o ,
I certify that the remains of the decedent identified above were disposed of in accords ce with this permit on:
Date of Disposition -3^�� Place of Disposition R/W�U`� �f/C�jr�j�-lo n('
(add ess
tu
(section) 0/ r�, ;�, urpber (grave number)
Name of Sexton or Person in Charge of Premises 1 f/ 2
(please print)
Signature _ Title `^Q eta T11
(over)
DOH-1555 (02/2004)
U E E
� ���8 U��
PINE VIEW CEM ETERY AND CREMATORIUM
QUA-KZR ROAD, Q(IEP.NSBVRY NE1,V YORK 17804
(518) 745.4476 (518) 745'.4477
Funeral Director
Cesef � (f
:a '. e Of Cremation
" e Cremation Started {
r �
Te Cremation Completed
;e c ! Container nn
� Ce ' '�
Town of Queensbury i
Pine View Cemetery and Crematorium
0;!!L-�
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518)745-4476, Crematorium: (518) 745-4477
Authorization to Cremate
The undersigned requests and authorizes Pine View Crematorium,in accordance with and subject to its Rules and Regulations to
cremate the remains of:
A49r-ie r -T• Few "
(Name) (Sex)
,516G `5144PA .oC,k cbelr► lea Le+' IJC a7(o l y
(Street) (City) tale) (zip Code)
who died on /S r day of 20 0-7t�W ,1
at ►4�-t" � K ST Lr"
, �"Ll
(Place) I (Address)
Name and address_of�nearest living relative or name of person authorizing cremation:
(Name) (Address) I—s
ReMonshlp to the deceased
Name of Funeral Home Q &Ad G � '
IMPORTANT:
I represent that to the hest of my knowledge,the deceased(has) has no maker,defibrillator,battery,battery pack,power
cell,radioactive implant or radioactive device in his or her body.(Ci e )
1 certify that I have full power and authorization to arrange for the cremation of the remains and to direct the disposition of the
cremated remains,that any personal possessions have either been removed or may be destroyed,and agree to protect,defend and
save harmless Fite View Crematorium from any and all claims and demands for loss or damages which may be made agairui them
by r connected with the cremation of said remains as directed,whether such claims or demands are or are not wholly
gr undless Ise or fraudulent.
(Witness) ( )
(Signature and ddrass of Relative or LedU Representative)
Signed on this date: r'µQ�� 3 206- -
Disposition of Cremated Remains
I hereby direct Pine View Crematorium to dispose of the cremated remains as follows:
Mail to
Other arrangements-Please specify: 2EMkJJ 711 rW ftA,(-, 00*L—
If pulverization of cremated remains is requested,check here
Revision:April 18,2007