French, Cynthia K ' if 13
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
, Name First Middle Last Sex
Cynthia Ann French Female
Date of Death Age If Veteran of U.S.Armed Forces,
08/03/2018 72 Years War or Dates
1.0 Place of Death Hospital, Institution or
City, Town or Village Albany Street Address St Peters Hospital
0 Manner of Death ,Natural Cause Accident Homicide Suicide Undetermined Pending
( Circumstances Investigation
.j Medical Certifier Name Title
Jenna Patterson NP
Address
315 S Manning Blvd,Albany,New York 12208
Death Certificate Filed District Number Register Number
City, Town or Village Albany 0101 1709
❑Burial Date Cemetery or Crematory
08/06/2018 Pine View Crematory
['Entombment Address
®Cremation Queensbury, New York
Date Place Removed
Removal and/or Held
and/or Address
Hold
Date Point of
go Transportation Shipment
by Common Destination
Carrier
Q Disinterment Date Cemetery Address
0 Reinterment Date Cemetery Address
" Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
i Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
tLI
0; Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/06/2018 Registrar of Vital Statistics Danielle S Gillespie(ElectronicallySigned)
(signature)
District Number 0101 Place Albany, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
IliDate of Disposition Q it, he Place of Disposition ?,,,�{�w erm. o'...
a (address)
W
to (section) (lotiumber) (grave number)
2 Name of Sexton or Person in Charge of Pr mises ((/A} S="'
sts
4 (please rint)
ILI Signature Title 1.17#04014.-
(over)
DOH-1555(02/2004)