Eldred, Colleen • 1c1g6
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
`„ Name First Middle' Last Sex
Colleen A Eldred Female
D• ate of Death Age If Veteran of U.S.Armed Forces,
} 0• 8/21/2018 69 Years War or Dates
Place of Death Hospital, Institution or
us City, Town or Village Glens Falls Street Address Glens Falls Hospital
2 Manner of Death El NaturalCause ID Accident D Homicide D Suicide D Undetermined El Pending
Circumstances Investigation
W Medical Certifier Name Title
0 Sean Bain 1 ..,, MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
F City, Town or Village Glens Falls 5601 402
DBurial Date Cemetery or Crematory
08/24/2018 " Pine View Crematory
DEntombment Address
®Cremation Queensbury, New York
-- Date Place Removed
D Removal and/or Held
if and/or Address
Hold
O Date Point of
• ❑Transportation Shipment
a by Common Destination
▪ Carrier
D Disinterment Date Cemetery Address
El Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
:, Address
c 53 Quaker Rd,Queensbury,New York 12804
'' Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
IX
w
_, Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/24/2018 Registrar of Vital Statistics Rg6ertA Curtis(E(ectronica((y Signed)
(signature)
District Number 5601 Place Glens Falls, New York
I- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition gin by Place of Disposition e, `tr--,
2 (address)
W
(section) (lo//number) C (grave number)
Q Name of Sexton or Person in Charge of Premises (Any v t.vitt
Z (please pint
W Signature "'t Title !iOttf_
(over)
DOH-1555 (02/2004)