Palmer, Sylvia NEW YORK STA -E DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Sylvia R. Palmer Female
Date of Death Age If Veteran of U.S. Armed Forces,
March 5, 2012 82 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Queensbury Street Address Stanton Nursing & Rehab Centre
raManner of Death ix Natural Cause Accident Homicide Suicide Undetermined -Pending
W Circumstances -Investigation
W Medical Certifier Name Title
• Roslyn Socolof,MD
Address
152 Sherman Ave.Queensbury,NY 12804
Death Certificate Filed Dist ict Number, Register Number
City, Town or Village Queensbury
0 Burial Date Cemetery or Crematory
❑Entombment March 9, 2012 Pine View Cemete -
ry
Address
❑Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
1' Hold
N
O Date ' Point of
yI 1 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 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
2 Address
Cd
W _
Permission is hereby granted to dispose of the huma remains described,above as indicated.
• Date Issued )c 'c� Registrar of Vital Statistics `-� O it l
(signature)
District Number qt., c i Place Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
UJ Date of Disposition 3/9/1 2 Place of Disposition Pine View Cemetery
W (address)
V)
0 (section)Ho B
icon (lotnumber) (grave number)
r Name of Sexton or Perso in Charge of Premises
Z ,g Michael GPniPr
(please print)
W Signature" _
-AA' Title Superintendent
(over)
DOH-1555(02/2004)