Majeed, Sharkila NEW YORK STATE DEPARTMENT OF HEALTH
'Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Shakila I. Majeed Female
Date of Death Age If Veteran of U.S. Armed Forces,
- December 3, 2011 71 War or Dates
• ' Place of Death
�= Hospital, Institution or
Z. City, Town or Village Glens Falls Street Address Glens Falls Hospital
cManner of Death I XI Natural Cause Accident I I Homicide f Suicide Undetermined -Pending
WW Circumstances Investigation
Medic Certiif er Name Title
Q. X"
C�-t e—\s - --kls Address �1
Death Certificate Filed District Number R n( tuber
City, Town or Village Glens Falls,NY 5601
El Burial Date Cemetery or Crematory
II Entombment December 6, 2011 Pine View Cemetery
Address
❑Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z I I Removal and/or Held
O and/or Address
H Hold
y
O Date Point of
NI I Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
- I
Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Funeral Home , 01443
Address
53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
1—, Remains are Shipped, If Other than Above
SAddress
w
A. Permission is hereby granted to dispose of the human remains described abo e as ' i ated.
Date Issued /02/O1,/10// Registrar of Vital Statistics ci ., `v
(signature)
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
w Date of Disposition 1 2/6/1 1 Place of Disposition Pine View Cemetery
2 (address)
W
0 Horicon 4H 2
(section) (lot number) (grave number)
O Name of Sexton or Persos4n harge of Premises
z 9 Michael Genier
LLJ c (please print)
Signature Title Superintendent
(over)
DOH-1555(02/2004)