Zitterman, Joan 4 to D 4
NEW YORK STATE DEPARTMENT OF HEALTH ` '
Vital Records SectionF Burial - Transit Permit
Name First Middle Last Sex
Joan Zitterman Female
=z; Date of Death Age q If Veteran of U.S. Armed Forces,
':eaa December 2, 2012 War or Dates
t°p;. Place of Death Hospital, Institution or
. City, Town or Village Lake George Street Address 42 Sewell St.
cs. Manner of Death X Natural Cause I 'Accident I Homicide Suicide Undetermined Pending
US - Circumstances Investigation
Medical Certifier Name Title
e Gary Scidmore, Coroner
Address
Warren County Municipal Center
;tl::; Death Certificate Filed District Number Register Number
:pppp' City, Town or Village s w Lake George fb CI I /
❑Burial Date Cemetery or Crematory
❑Entombment December 5,2012 , Pine View Crematorium
Address
El Cremation 21 Quaker Road, Queensbury,NY 12804
Date Place Removed
Z I" I Removal and/or Held
2 and/or Address
H Hold
co
0 Date Point of
O.
N Transportation Shipment
p by Common Destination
Carrier
I I Disinterment Date 1 Cemetery Address
Reinterment Date Cemetery Address
>j: Permit Issued to Registration Number
ps, Name of Funeral Home Regan & Denny Stafford Funeral Home 01443
• Address
:!:: 53 Quaker Road,Queensbury,NY 12804
.-v. Name of Funeral Firm Making Disposition or to Whom
ei+* Remains are Shipped, If Other than Above
Address
AZ
• : Permission is hereby granted to dispose of the human remains describ d above as 'ndicated.
>:• ,.
.;-,: Date Issued 4 j 5/�� Registrar of Vital Statistics 2
(signature)
?i• :: District Number e
,j?� Place Lake Georg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
�z `� yc C, t `
Date of Disposition «-'}-tZ Place of Disposition „�U � b('+��-
E (address)
N
CL (section) 1 - (lot number (grave number)
o Name of Sexton or Person in Charge of Premises r,/ r jn f-
Z tease print)
W Signature 1( , Title GR M Kat
(over)
DOH-1555(02/2004)