Gilman, Isabelle I
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
,tire:; Name First Middle Last Sex
▪:j Isabelle Gilman Female
W.:, Date of Death Age If Veteran of U.S. Armed Forces,
: September 13,2015 78 War or Dates
•• Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death I XI Natural Cause Accident n Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
MD
•
1titi ;
Sean Bain
r Address
':•' 100 Park Street Glens Falls,NY 12801
Death Certificate Filed District Number / Register M
:rj; City, Town or Village Glens Falls, NY �!j d
❑X Burial Date Cemetery or Crematory
September 17,2015 Pine View Cemetery
❑Entombment -Address
❑Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
F Hold
U)
O Date Point of
N Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
: Permit Issued to Registration Number
r 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
:;rr Permission is hereby granted to dispose of the human rem ins d ribed a ve as ind' - ..
▪ Date Issued / Registrar of Vital Sta 'stics . Z_i t 4 Uc21 -
{:;: (signature)
District Number 66, 7 Place I A >/v
,:::::
I certify that the remains of the decedent identified above were disposed of in accoy6ance with this permit on:
I—
w Date of Disposition 9/1 7/1 5 Place of Disposition Pine View Cemetery, Queensbury, NY
2 (address)
W
U) Erie 58A 1
(section) (lot number) (grave number)
0• Name of Sexton or Person in Charge of Premises Connie L. Goedert
z (please print)
W ASignature d./tee,,,4Title Cemetery Superintendent
(over)
DOH-1555(02/2004)