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Knois, Cheryl Ann
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Cheryl Ann Konis Female Date of Death Age If Veteran of U.S.Armed Forces, 02/04/2020 59 Years War or Dates il Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W Manner of Death Undetermined Pending W © Natural Cause Accident ❑Homicide Suicide Circumstances Investigation W Medical Certifier Name Title 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 60 ❑Burial Date Cemetery,Crematory or Facility Name 02/10/2020 Pine View Crematorium Entombment Address X❑Cremation Queensbury Town,New York Donation Z Removal Date Place Removed and/or and/or Held P Hold Address Cl) O a Date Point of Cl) ❑Transportation p by Common Shipment Carrier Destination El Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67, Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition orto Whom F- Remains are Shipped,If Other than Above Address ir W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/06/2020 Registrar of Vital Statistics (R96ertAndrew Curtis(ECectronicallySigned) (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 W Date of Disposition 'Z 1li 1 ZO Place of Disposition A� W (address/ W Cl) (section) (lot number/ (grave number) OVAI a Name of Sexton or Person in Charge of Premise t r (PItaseprind /^ W Signature Title ` DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145 2b ' . 1 3 2 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#