Loading...
Eddy, Helen s it 213 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Helen F Eddy Female Date of Death Age If Veteran of U.S. Armed Forces, 04/03/2018 79 Years War or Dates Place of Death Hospital, Institution or r•a City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause 0 Accident D Homicide ID Suicide ❑Undetermined Pending Circumstances Investigation Medical Certifier Name Title Michael Miles MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 167 ❑BUI'lal Date Cemetery or Crematory 04/05/2018 Pineview Crematorium •<: D Entombment Address ®Cremation Queensbury Town, New York Date Place Removed 3R ❑Removal and/or Held 4 4: and/or Address Hold Date Point of Q Transportation Shipment by Common Destination Carrier • Q Disinterment Date Cemetery Address Q Renterment 4Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 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 04/04/2018 Registrar of Vital Statistics WpbertA Curtis(E(ectronicallySigned) 01. (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: « . Date of Disposition q/3 hi Place of Disposition E,,461 C� 4 ,; (address) (section) (lot nymber) (grave number) Name of Sexton or Person in Charge of Premises (please print) Signature Title C(.fh r� (over) DOH-1555(02/2004)