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Randall, Joan NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Joan A.Randall Female Date of Death Age If Veteran of U.S. Armed Forces, is 11/14/2018 80 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause Accident El Homicide 0 Suicide ri Undetermined n Pending " I—I Circumstances Investigation Medical Certifier Name Title Marvin Davidowitz MD Address 100 Park St,Glens Falls,New York 12801 04 Death Certificate Filed District Number Register Number • City, Town or Village Glens Falls 5601 539 ❑Burial Date Cemetery or Crematory 11/16/2018 Pineview Crematorium QEntombment Address ®Cremation Queensbury Town, New York Date Place Removed El Removal and/or Held and/or Address • Hold Date Point of Q Transportation Shipment by Common Destination Carrier Q Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number ve Name of Funeral Home Radloff Funeral Home Inc 01425 Address 136 Warren St,Glens Falls,New York 12801 444 to Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above x Address Permission is hereby granted to dispose of the human remains described above as indicated. , Date Issued 11/16/2018 Registrar of Vital Statistics Wp6ertA Curtis(E1 ctronwallySigned) (signature) District Number Place 5601 Glens Falls, New York 4., I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: • Date of Disposition///,(o-/tjj Place of Disposition 2.))4A);e, ‘re.,�/J J-0,1,,v+ (address) '$ (section) (lot number) (grave number) • Name of Sexto P rs in Charge of Premises AL„.1' 1 Ger7' -`- . (please print) Signature Title C rQ- w (over) DOH-1555 (02/2004)