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Tacardon, Margaret A. #�g NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Margaret A Tacardon Female Date of Death Age If Veteran of U.S.Armed Forces, 01/21/2020 73 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation p Mannerof Death © Natural Cause Accident Homicide Suicide Undetermined Pending V Circumstances Investigation QMedical 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 orVitlage Glens Falls 5601 42 ❑Burial Date Cemetery,Crematory or Facility Name 01/24/2020 Pine View Crematory Entombment Address FXJ Cremation Queensbury Town,New York Donation Z Removal Date Place Removed Fand/or and/or Held N Hold Address g ❑Transportation Date Point of a 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 }. Remains are Shipped,If Other than Above Address Q W I' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/24/2020 Registrar of Vital Statistics WpbertAndrew Curtis(ECectronicaClySignec) /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: � W Date of Disposition 112q/zo Place of Disposition �,u V., (�c (address) W U) (sedan/ (tot number) (grave number) Name of Sexton or Person in Charge of remises r'I z (p/ease print) W Signature Title DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#