Stern, Meta NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Meta R. Stern Female
Date of Death Age If Veteran of U.S. Armed Forces,
July 23,2013 94 War or Dates
I- Place of Death Hospital, Institution or
Z City,Town or Village Glens Falls Street Address 86 Sheridan Ave
pManner of Death 0 Natural Cause 0 Accident 0 Homicide Suicide ❑Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
G Robert Tedesco,MD
Address
Glens Falls,NY
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls,NY 5601 3.0
®Burial Date Cemetery or Crematory
0 Entombment July 25,2013 Shaaray Tefila
Address
❑Cremation Media Drive,Queensbury,NY 12804
Date Place Removed
ZZ El Removal and/or Held
and/or Address
H Hold
N
O Date Point of
N Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped, If Other than Above
2 Address
W
n' Permission is hereby granted to dispose of the human remains describe abo e as 'ndi,
%.
Date Issued 0Oy/2O,i Registrar of Vital Statistics ature
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:
W Date of Disposition Place of Disposition S\,t,L �- r , (a-_
2 ( d )
(sect n)-- lot number) (grave number)
pName of Sexton or Person in Charge of Premises �vG U(N- 7
• )
Signature Title
(over)
DOH-1555(02/2004)