Howe, Lena NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Lena Belle Howe Female
Date of Death Age If Veteran of U.S.Armed Forces,
08/30/2018 94 Years War or Dates 44-46
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation
Manner of Death Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Gwendolyn Morris-Dickinson PA
Address
170 Warren St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 416
®Burial Date Cemetery or Crematory
09/08/2018 Pine View Cemetery
❑Entombment Address
['Cremation Queensbury, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
El Disinterment Date Cemetery Address
❑Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 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 remains described above as indicated.
Date Issued 08/31/2018 Registrar of Vital Statistics R96ertA Curtis(Efectronica[(ySigned)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 9/8/201 8 Place of Disposition Pine View Cemetery Queensbury
(address)
Mohican 57-E 2
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises Connie Goedert
(please print)
SignatureCejtAti -" � -4-1 Title Cemetery Superintendent
(over)
DOH-1555(02/2004)