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Warrington, IsabellNEW YORKSTATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Isabell S Warrington I Female Date of Death Age If Veteran of U.S. Armed Forces, 10/17/2019 93 Years War or Dates II.— Place of Death Hospital, Institution or Z City, Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc LU Manner of Death ©Natural Cause El Accident Homicide Suicide Undetermined ❑ Pending p Circumstances Investigation W Medical Certifier Name Title G Michael Miles MD Address 319 Broadway, Fort Edward Town, New York 12828 Death Certificate Filed District Number Register Number City, Town or Villa a Fort Edward 5755 84 © Burial Date Cemetery, Crematory or Facility Name Entombment 10/21/2019 Pine View Cemetery Address Cremation Queensbury Town, New York Donation z Removal Date Place Removed and/or Held F Hold Address Nand/or O a Date Point of N p Transportation by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment 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 IH Remains are Shipped, If Other than Above Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/17/2019 Registrar of Vital Statistics Aimee ilfahoney (E(ectronically Signed) (signature/ District Number 5755 Place Fort Edward, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H Z Date of Disposition Place of Disposition W(address/ uJ N M (section/ (lot number/ (grave number/ C Name of Sexton or Person in Charge of Premises Z (please print/ W Signature Title DO H-1555 (o7/18) p 1 of 2 Public Health Law Sec. 4145(2b) 010349 Receipt r~ Human remains of &"! r` rC (rdelivered on `� -4 , 20 4 t-- t Pine View rn tery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License #