Saville, Carolyn NEW YORK STATE DEPARTMENT OF HEALTH- s • I I
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Carolyn J Saville Female
Date of Death Age If Veteran of U.S. Armed Forces,
10/08/2017 92 War or Dates
_ Place of Death Hospital, Institution or
Z City, Town or Village Moreau Street Address 19 Washington Rd
0 Manner of Death I X I Natural Cause [Accident n Homicide n Suicide n Undetermined n Pending
W Circumstances Investigation
Medical Certifier Name Title
Glen Anderson PA
Address
6 Carey Rd.Queensbury,NY 12804
Death Certificate Filed District Number Register umber
City, Town or Village Moreau 4562 (j
0 Burial Date Cemetery or Crematory
Entombment October 10,2017 Pine View Crematorium
Ei Address
®Cremation 51 Quaker Road,Queensbury,NY 12804
Date Place Removed
0 I I Removal and/or Held
and/or Address
E Hold
N
Q Date Point of
N n Transportation Shipment
p by Common Destination
Carrier
El Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd.,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
XRemains are Shipped, If Other than Above
Address-
to
a- Permission is hereby granted to dispose of the human remain cribs b e as indicated.
Date Issued f O J/0%t) Registrar of Vital Statistics Hatt?
(signet re)
District Number J ��-- Place 6417/(VS led' /4()')a q t /d Y ?
E- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition /off///n Place of Disposition 'inter ar niz f o IT'
la (address)
CO
W
(section) 4�j ,(lot number) e. (grave number)
p Name of Sexton or Person in Charge of Premises r,, mid
z (pl ass print)
W
Signature 4 f Title CO 1 if2:1/4—
(over)
DOH-1555(02/2004)