Coon, Isabel NEZYORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
V; Isabel M. Coon Female
Date of Death Age If Veteran of U.S. Armed Forces,
F August 25,2012 86 War or Dates
>r' Place of Death
i Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
It Manner of Death 0 Natural Cause i l Accident ❑Homicide ❑Suicide ri Undetermined n Pending
Circumstances Investigation
tis
Medical Certifier Name Title
Michael Adams,MD
Address
South Glens Falls,NY
Death Certificate Filed District Number Register Number
• City, Town or Village Glens Falls,NY 5601 ,VA
®Burial Date Cemetery or Crematory
❑Entombment August 28,2012 Pine View Cemetery
Address
❑Cremation Quaker Road, Queensbury,,NY 12804
Date Place Removed
ZZ ❑Removal and/or Held
and/or Address
r- Hold
N
O Date Point of
N ❑Transportation Shipment
p by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
s• Permit Issued to Registration Number
• Name of Funeral Home Regan& Denny Stafford Funeral Home 01444 \.
Address
94 Saratoga Ave, South Glens Falls, NY 12803
Name of Funeral Firm Making Disposition or to Whom
l Remains are Shipped, If Other than Above
Address
1
7 Permission is hereby granted to dispose of the human remains describedAL/
above siry. ccaated.
Date Issued 6,5r27/,.2
0/z—Registrar of Vital Statistics `G,r.� �
(signature)
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
ui Date of Disposition 8/28/1 2 Place of Disposition Pine View Cemetery
(address)
uu)j Uncas 1030 Sec. 22 2
re (section) (lot number) (grave number)
pName of Sexton or Person i Charge of Premises Michael Genier
Z (please print)
W Signature c`'" fw Title Superintendent
(over)
DOH-1555(02/2004)