Parsons, Kathryn NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
`r Kathryn Grace Parsons Female
Date of Death Age If Veteran of U.S. Armed Forces,
May 21, 2017 2 War or Dates N4�-
: v Place of Death Hospital, Institution or
City, Town or Village Schroon Street Address 1170 US Route 9 Apt#1
Manner of Death ❑X Natural Cause Accident ❑Homicide Suicide n Undetermined n Pending
.# Circumstances Investigation
Medical Certifier Name Title
Alexander Gozman Dr.
Address
47 New Scotland Ave,Albany,NY 12207
`; Death ificate Filed District Number Register Number
?' City, own r Village SSG '1/Do/— /
❑Burial Date{ owl 7 Cemetery or Crematory
El Entombment // Pine View Crematorium
Address
❑x Cremation •51 Quaker Road,Queensbury, NY 12804
Date Place Removed
ZZ ❑Removal and/or Held
and/or Address
E Hold
U)
O Date Point of
05 ❑Transportation Shipment
a by Common Destination
Carrier
n Disinterment Date Cemetery Address
El Reinterment Date Cemetery Address
i Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
ki Address
ei 53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
'`.` Remains are Shipped, If Other than Above
Address
-,: Permission is her by g anted to dispose of the human r ain described abo e as indicated.
,�t;.: '
Date Issued �0�3 1'`7 Registrar of Vital Statistics ���
tt _-- (signature)
S'{=}'1 District Number I j - Place &-jv cS
I certify that the remains of thej decedent identified above were disposed of
`i'n accordance with this permit on:
Z Disposition1 I i1 Disposition '1 t+ 11 Lri-r�cl'k�"';w�...
Date of �IZ Place of ,
W (address)
U)
CC (section) ' (lot number) ( (grave number)
QName of Sexton or Person in Charge of Premises /4f. JPin t It
Z (ple se print)
W Signature �(. Title (RE 111A 1Z(�
(over)
DOH-1555(02/2004)