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Peets, Joan NEW YORK SATE DEPARTMENT OF HEALTH Burial - Transit Permit Vital Records Section Name First Middle Last Sex Joan Peets Female Date of Death Age If Veteran of U.S. Armed Forces, December 28, 2013 79 War or Dates H Place of Death Hospital, Institution or Z City, Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death n Natural Cause n Accident Homicide n Suicide n Undetermined n Pending Circumstances Investigation W Medical Certifier Name Title G Dr.Tedesco Address 3 Irongate,Glens Falls,NY 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 5 12_ ©Burial Date Cemetery or Crematory ❑Entombment Address ❑Cremation Date Place Removed ZO n Removal and/or Held and/or Address E" Hold Cl) O Date Point of NLi Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address n 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 Ce W a Permission is hereby granted to dispose of the huma emains escribe bove as ' dicated. Date Issued /a 3t �p/� Registrar of Vital Statistics G� )Z .13 �_ (signature) District Number 5601 Place Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 1 /6/1 4 Place of Disposition Pine View Cemetery W (address) U) Hudson Sec. 3 35 D 1 0 (section) (lot number) (grave number) QName of Sexton or Person in Charge of Premises Connie L. Goedert Z  Superintendent (please print) W Signature l ri-1..; Title P (over) DOH-1555(02/2004)