Giordano, Constance Helene NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Last Sex
Constance Helene Giordano Female
Date of Death Age If Vete of U.S.Armed Forces,
11/20/2019 73 Years War• !ates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
W
up Manner of Death 0 NaturalCause �AccMmt �Homicide �Suicide �Undetermined �Pending
C.) Circumstances Investigation
W Medical Certifier Name Title
0 Marvin Davidowitz MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 499
Burial Date Cemetery,Crematory or Facility Name
11/20/2019 Pine View Crematory
Entombment Address
RiCremation Queensbury Town,New York
Donation
Z Removal Date Place Removed
O and/or and/or Held
~ Hold Address
N
O
IL Date Point of
Uf ❑Transportation
p by Common Shipment
Carrier Destination
El Disinterment
Date Cemetery Address
1EIReinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Il- Remains are Shipped,If Other than Above
2 Address
X
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/20/2019 Registrar of Vital Statistics Wp&&,7ndhewCurt&(Ekctmnica.TySi,=4
(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:
H
Z Date of Disposition Place of Disposition Qc--
W
2 (address)
W
U)IM (section) (lot number) (grave number)
r
SName of Sexton or Person in Charge of Premise ��r
Z /p/ease print)
W Signature Title )
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) `� 0 1 3 Q g 8
Receipt
Human remains of , delivered on 20
, l
$ne View Cemetery Representinoe funeral home named.on burial permit
Official Funeral Directors Reg.or License# 4 +'