Castellano, Ida NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
ti' Name First Middle Last Sex
Ida M. Castellano Female
Date of Death Age If Veteran of U.S. Armed Forces,
::::: August 10, 2014 91 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
ti. Manner of Death
X Natural Cause Accident ❑Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
gi Wendy Steinhacker
Address
100 Park Street,Glens Falls,NY 12801
is Death Certificate Filed District Number Reg! IjOixber
'•:•: City, Town or Village Glens Falls 5601
yx
CI Burial Date Cemetery or Crematory
❑Entombment August 12, 2014 Pine View Cemetery
Address
❑Cremation Quaker Road, Queensbury, , NY 12804
Date Place Removed
ZZ I ]Removal and/or Held
and/or Address
H Hold
Cl)
O Date Point of
NTransportation Shipment
a 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
Remains are Shipped, If Other than Above
Address
' : Permission is hereby granted to dispose of the human ains scribed ab ve as indic. ed.
Date Issued p/ Registrar of Vital Statistics
e'/ 414 ?
` (signature)
rti District Number Place
5601 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 8/12/14 Place of Disposition Pine View Cemetery
W (address)
co Seneca 33 A 2
CL (section) (lot number) (grave number)
Q Name of Sextonr� or Person in Charge of Premises
Connie L. C,oeder(tp�g
Z Su rinteYltrierint)
LU Signature( . - t..,w 'e_.0 .p G�-e., V Title
(over)
DOH-1555(02/2004)