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Crowles, Jean NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex 4.1 Jean M.Cowles Female tti Date of Death Age If Veteran of U.S. Armed Forces, 04/26/2018 70 Years War or Dates Place of Death Hospital, Institution or r,:i City, Town or Village Glens Falls Street Address Glens Falls Hospital #v3 Manner of Death Undetermined Pending 7': ©Natural Cause Accident Homicide Suicide .. Circumstances Investigation . ' Medical Certifier Name Title Noelle Stevens MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number r City, Town or Village Glens Falls 5601 211 • ❑Burial Date Cemetery or Crematory "�.. 04/27/2018 Pineview Crematorium Li Entombment Address i®Cremation Queensbury Town, New York , Date Place Removed 7:: Removal ,.� � and/or Held ,- and/or in Address '' Hold Date Point of Q Transportation Shipment by Common Destination Carrier IN Q Disinterment Date Cemetery Address W Date Cemetery Address kt ❑Reinterment Permit Issued to Registration Number 74 Name of Funeral Home Densmore Funeral Home Inc 00448 PI Address 7 Sherman Ave,Corinth,New York 12822 • Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above - s Address 4.4 Permission is hereby granted to dispose of the human remains described above as indicated. gam,, Date Issued 04/27/2018 Registrar of Vital Statistics qp6ertA Curtis-(Efectronica1TySigned) (signature) !: District Number 5601 Place Glens Fails, New York tio • I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: n Date of Disposition H 110 Ili Place of Disposition g Ui t ut- 3 (addre ) "I (section) ylf(lot number? (grave number) ' Name of Sexton or Person in Charg of Premises aim *vpt ()lase print) Signature a Title I of (over) DOH-1555 (02/2004)