Stevens, Rose NEW YORK STATE DEPARTMENT OF HEftTl-F' '
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
at Rose Beatrice Stevens Female
Date of Death Age If Veteran of U.S. Armed Forces,
12/24/2018 96 Years War or Dates
• Place of Death Hospital, Institution or
• City, Town or Village Granville Town Street Address The Orchard Nursing And Rehabilitation Centre
• Manner of Death E Natural Cause ❑Accident ❑Homicide ❑Suicide ri❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Leonard Gelman MD
Address
k 10421 State Route 40,Granville Town,New York 12832
j Death Certificate Filed District Number Register Number
City, Town or Village Granville 5756 70
❑Burial Date Cemetery or Crematory
12/27/2018 Pine View Crematory
❑Entombment
( Address
®Cremation Queensbury, New York
Date Place Removed
❑• Removal and/or Held
and/or Address
Hold
Date Point of
• ❑Transportation Shipment
by Common Destination
: Carrier
• ❑Disinterment Date Cemetery Address
❑Reinterment
Date Cemetery Address
4 Permit Issued to Registration Number
Name of Funeral Home Regan&Denny Funeral Service 01444
Address
94 Saratoga Ave,S Glens Falls,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
TT
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/27/2018 Registrar of Vital Statistics Jenny Linda Martel (Electronically Signed)
(signature)
District Number Place
5756 Granville, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
11 Date of Dispositionp....Lg4-jg Place of Disposition pi ft., VitvJ c�,,,cocy
ril 1 (address)
'I)
(section) (lot number) (grave number)
..• Name of Sexton or Person in Charge of Premises sc,1r"-c•Y Squirt-S
` (pease print)
Signature Title Qi{`t,"q+"a'r
(over)
DOH-1555 (02/2004)