Perone, Sandie < < x # 325-
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
' Name First Middle Last Sex
Sandie Perone Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/08/2017 61 Years War or Dates
Place of Death Hospital, Institution or
ci City, Town or Village Glens Falls Street Address Glens Falls Hospital
_ Manner of Death Fej Natural Cause ElAccident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
'ff. Darci Gaiotti-Grubbs MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 372
❑Burial Date Cemetery or Crematory
07/10/2017 Pine View Crematory
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
O. Date Point of
lo Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
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 07/10/2017 Registrar of Vital Statistics &g6ertACurtis Elecdnn1caayS/gner
(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:
p
Date of Disposition /Jll�(, Place of Disposition �(,,eO�. rant/" orn.-.
(address)
(section) lot number) (^ (grave number)
ti Name of Sexton or Person in Charge of Premises 6r.; Js.v,[11
(plea print)
Signature - 4 r Title CgE/M►}(�
(over)
DOH-1555(02/2004)