Corlew, Tamala . V 1 7‘c
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section r. Burial - Transit Permit
4 Name First Middle Last Sex
Tamale J.Coriew Female
-_ D• ate of Death Age If Veteran of U.S.Armed Forces,
th 09/19/2018 56 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death 0 Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
11 Medical Certifier Name Title
` 1 Shahid Ahmed MD
Address
100 Park St,Glens Falls,New York 12801
• Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 449
❑Burial Date Cemetery or Crematory
09/21/2018 Pineview Crematorium
❑Entombment Address
®Cremation Queensbury Town, New York
rt Date Place Removed
'_: ❑and/or Removal and/or Held
:= Address
i-°"ri Hold
f
is-
_ , Date Point of
• ❑Transportation Shipment
by Common Destination
Carrier
`,x ❑Disinterment Date Cemetery Address
• Reinterment Date Cemetery Address
Permit Issued to Registration Number
rg-
IA N• ame of Funeral Home Densmore Funeral Home Inc 00448
Address
w, 7• Sherman Ave,Corinth,New York 12822
a• . Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
-' Address
v.s. Permission is hereby granted to dispose of the human remains described above as indicated.
fa
Date Issued 09/21/2018 Registrar of Vital Statistics Rp6ertA Curtis(EfectronicalfySigned)
(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:
.i
Date of Disposition 9Ijii hI$ Place of Disposition ft.,IL- ltk`t0 ../
:_ (address)
` (section) num1ber) (grave number)
, g Ih , i
Name of Sexton or Person in Charge of Pre 'ses r, r s'+
„ (plea be print)
k;4 Signature /.i Title fetion
loft
(over)
DOH-1555(02/2004)