Townsend, Sandra NEW YORK STATE DEPARTMENT CitF H R.TH Burial
Vital Records Section - Transit Permit
Name First Middle Last Sex
Sandra L. Townsend Female
Date of Death Age If Veteran of U.S.Armed Forces,
i. March 17, 2017 80 War or Dates
Z Place of Death Hospital, Institution or
W City,Town,or Village Glens Falls Street Address Glens Falls Hospital
0 Manner of Death n Natural Cause n Accident 0 Homicide ❑Suicide ❑Undetermined 0 Pending
W Circumstances Investigation
(a Medical Certifier Name Title
W Dr. Dean Reali, M.D. Dr.
0 Address
3767 Main Street, Warrensburg, NY 12885
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls \ 1 -70
❑Burial Date Cemetery or Crematory
March 21, 2017 Pineview Crematorium
n Entombment Address
a, ❑X Cremation 21 Quaker Road Queensbury, NY 12804
Date Place Removed
0 0 Removal and/or Held
- and/or Address
Im Hold
0 Date Point of
0 El Transportation Shipment
D. by Common Destination
Carrier
Date Cemetery Address
5 n Disinterment
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Jillson Funeral Home, Inc. 00885
Address
46 Williams Street, Whitehall, New York 12887
~ Name of Funeral Firm Making Disposition or to Whom
2 Remains are Shipped, If Other than Above
X
W Address
O.
Permission is hereby ranted to dispose of the human r�mains described ab e as indicat .
Date Issued 0 j�' Registrar of Vital Statistics efi7:v �.. �l
(signature)
District Number .5"(pj{ / Place Glens Falls,New Yor
F I certify that the remains of the decedent identified above were disp of in accordance with this permit on:
Z
W Date of Disposition 03/21/2017 Place of Disposition Pineview Crematorium
2 (address)
W
0
CC 0 (section) c4 (lo;number) (grave number)
Name of Sexton o ers in Charge of Premises /11,,� yyl e...!y e-
Z (please print)
W
Signature Title e_rgiyttad./
(over)
DOH-1555 ( /2004)