Parent, Robin w
4
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
IF? Name First Middle Last Sex
Robin A. Parent Female
IDate of Death Age If Veteran of U.S. Armed Forces,
November 9,2016 57 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Queensbury Manner of Death
Street Address 66 Alpine Avenue
Ti Natural Cause n Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
John P. Stoutenburg Dr.
f,1, Address
0: Glens Falls Hosp, Glens Falls,NY 12801
Death Certificate Filed District Number R�gtister Number
� % City, Town or Village Queensbury 5657 1 - "4
❑x Burial Date Cemetery or Crematory
November 14, 2016 Pine View Cemetery
❑Entombment Address
❑Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z n Removal and/or Held
and/or Address
h' Hold
O Date Point of
G.
Transportation Shipment
a by Common Destination
Carrier
Ti Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
>> Name of Funeral Home Regan Denny Stafford Funeral Home 01443
frx Address
;P:a Q uaker 53 Road, Queensbu ry, 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 r a'ns described abpv as indicated.
'`
cll
{ Date Issued` 11 ) t O Registrar of Vital Statistics C-- C1 Ct ----_.--
'. (signature)
District NumberPlace
,�' 5657 Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
iii Date of Disposition 1 1 /1 4/1 6 Place of Disposition Pine View Cemetery, Queensbury, NY
(address)
LLI
U) Huron 1 1 B 2
re (section) (lot number) (grave number)
pName of Sexton or Person in e of Premises Connie L. Goedert
Z /� �po (please print)
W Signature GSA'-!{ X '�.Q Gt Title Cemetery Superintendent
(over)
DOH-1555(02/2004)