Parrott, Virginia : fr (�
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
L Name First Middle Last Sex
.
virg Virginia S Parrott LFemale
•
1 Date of Death Age L f Veteran of U.S. Armed Forces,
• Place of Death - 82 Years War or Dates
Hospital, Institution or
� Manner of Death 9 '� '�,L ; Homicide Glens Falls Hospital
1 City, Town or Village Glens Falls Street Address
i jX1 Natural Cause f Accident Suicide I Undetermined Pending
Circumstances Investigation
° Medical Certifier Name Title
Mathew Varughese DO
Address
}'. 100 Park St,Glens Falls,New York 12801 j
' Death Certificate Filed District Number 1 Register Number
City, Town or Village Glens Falls 5601 404
• Li Burial Date j Cemetery or Crematory
• — 08/27/2018 I PineView Crematorium
Entombment Address
K Cremation Queensbury Town, New York
1
t.k Date Place Removed
Removal and/or Held
and/or
Address
'-:'63' Hold
i I
Date Point of
j Transportation Shipment
- by Common Destination
Carrier
Date 1 Cemetery Address
x Disinterment I
Reinterment Date Cemetery Address
Permit Issued to T Registration Number
Name of Funeral Home Mason Funeral Home , 01117
i• Address
a, 18 George St Po Box 277, Fort Ann, New York 12827-0277
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
' 't` Date Issued 08/27/2018 Registrar of Vital Statistics Robert Curtis(ECectronicatTy Signed)
rg (signature)
District Number 5601 Place Glens Falls, New York
el
tejs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
1? Date of Disposition i I n t‘, Place of Disposition f...t, # -.,
(address)
(section) I pot number) (grave number)
64 Name of Sexton or Person in Charge of Premises 1l'i z ' 9 I
de
(pleas print)
rats i-_ _ _ _A
Signature _ J Title __
(over)
DOH-1555 (02/2004)