West, Christena, Mae NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit VVV
Bureau of Vital Records
Name First Middle Last Sex
Christena Mae West Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/24/2019 96 Years War or Dates
f,. Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address 8 Flandreaux Avenue,Glens Falls,New York 12801
p Manner of Death 91 Natural Cause Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
Glen Anderson PA
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 505
Burial Date Cemetery,Crematory or Facility Name
11/26/2019 Pine View Crematory
Entombment Address
X Cremation Queensbury,New York
11 Donation
Z Removal Date Place Removed
O and/or and/or Held
N
~ Hold Address
O
IL Date Point of
UN ❑Transportation Shipment
Q by Common
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
F.. Remains are Shipped,If Other than Above
Address
Q
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/26/2019 Registrar of Vital Statistics TpAtrt hdtrwCunzr(Ekatronwad Signed)
(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:
F
Z Date of Disposition 1/1216111 Place of Disposition E.g., t]--
W (address)
a
W
� (section) (/ot number/ (grave number)
8O Name of Sexton or Person in Charge of Pr ises
Z �� /pl se print/
W Signature ,,. Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(21--*)
: 13105
Receipt
Human remains of .f delivered on , 20
Pine View Ce tery kepreseyidng the funeral home named on burial permit
Official Funeral Directors Reg.or License#
1