McAuley, Karen 1• s 1
NEW YORK STATE DEPARTMENT OF HEALTH / Ait 351
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Karen L. McAuley Female
Date of Death Age If 1leteran of U.S. Armed Forces,
• : May 2,2017 64 War or Dates
• Place of Death Hospital, Institutiort®rRiverview St.Building B, Apt#110,
' iXXxt% b Village South Glens Falls Street Address S.Glens Falls
• 2 Manner of Death ❑X Natural Cause n Accident ❑Homicide n Suicide n Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
William M.Parker MD
f Address
. 100 Broad Street,Glens Falls,NY 12801
go Death Certificate Filed }h District Number Register Number
lootgoinmexVillage Glens Falls _
El Burial Date Cemetery or Crematory
El Entombment May 4, 2017 Pine View Crematorium
Address
❑x Cremation 51 Quaker Road, Queensbury, NY 12804
Date Place Removed
ZZ Removal and/or Held
and/or Address
H Hold
Cl)
O Date Point of
Nn Transportation Shipment
'p by Common Destination
_ Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
``'
s� Permit Issued to Registration Number
" Name of Funeral Home Regan& Denny Funeral Home 01444
"i Address
. .;:� 94 Saratoga Avenue, South Glens Falls,NY 12803
`::: Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
iigi Permission is hereby granted to dispose of the human re i s described ab as indicated.
_:: Date Issued 1).51 Li) /7 Registrar of Vital Statistics ,X.../tfL. / q J
(signature)(
District Number Joy L( Place V(a, =5 't� S /-_'
yo
I certify that the remains of the decedent identified above were isposed of in accordance with this permit on:
9
LUDate of Disposition ( r) () Place of Disposition PrV�, .1.. ii.k„nr�ton-.r
2 (address)
LIJ
re (section) ;i/ (Ipt number) l (grave number)
00 Name of Sexton or Person in Charge of Premises f ,,.,, }w J enn&
Z (ple'se print)
III
Signature �,,, Title (Ren " 7.--
(over)
DOH-1555(02/2004)