Mahoney, Geradine /7 7/
NEW YORK STATE DEPARTMENT OF HEALTH •
Vital Records Section Burial - Transit Permit
? Name First Middle Last Sex
, Gerardine M Mahone yy Female
Date of Death Age If Veteran of U.S. Armed Forces,
05/30/2018 70 Years War or Dates
y Place of Death Hospital, Institution or
City, Town or Village Glens Falls Streetomicide Address TheSuicide Pines At Glens Falls Center For Nursing&Rehabilitation
Manner of Death Natural Cause Accident H ❑Undetermined ❑Pending
Circumstances Investigation
Medical 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 or Village Glens Falls 5601 278
= ❑Burial Date Cemetery or Crematory
w y
06/01/2018 Pine View Crematory
❑Entombment Address
ril
®Cremation Queensbury, New York
Date Place Removed
❑Removal and/or Held
and/or Address
-p: Hold
.r�
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
❑Disinterment
Date Cemetery Address
E Reinterment
Date Cemetery Address
Permit Issued to Registration Number
4,1 Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
'r 53 Quaker Rd,Queensbury,New York 12804
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.
Date Issued 06/01/2018 Registrar of Vital Statistics Ruben A Curtis(E(ectronica(fySigned)
(signature)
District Number 5601 Place Glens Falls, New York
n
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2 p
tW Date of Disposition 4/5 Ii 9 Place of Disposition 1 JL,- 4.44•n„
al (address)
0
US
(section) ,r)((lot number) (grave number)
Name of Sexton or Person in Charge o Premises L/'A+rQ�r w,/�
�t (phase print)
Signature et Title 012
(over)
DOH-1555(02/2004)