Manning, Deborah E I. # ,S-
NEW YORK STATE DEPARTMENT OF HEALTH 1
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Deborah A. Manning Female
Date of Death Age If Veteran of U.S. Armed Forces,
NIII 02/27/2017 56 yrs. War or Dates No
}- Place of Death City of Hospital, Institution or
City, Town or Village C1 P-is Pal 1 s Street Address Glens Falls Hospital
C3 Manner of Death®Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined 0 Pending
111 Circumstances Investigation
in Medical Certifier Name Title
William Cl paver M_1)_
Address
100 Park Street, Glens Falls, New York 12801
;s; Death Certificate Filed City of District Number 3601 Register Number
City, Town or Village Glens Falls t. 33
['Burial Date Cemetery or Crematory
02/28/2017 Pine View Crematory
['Entombment Address
®Cremation Queensbury, New York
Date Place Removed
❑Removal and/or Held
and/or Address
1:: Hold
U)
0 Date Point of
lbEl Transportation Shipment
C! by Common Destination
Carrier
❑Disinterment Date Cemetery Address
B.❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Wilcox & Regan funeral home 01 821
Address
11 Algonkin St. , Ticonderoga, New York 12883
Name of Funeral Firm Making Disposition or to Whom
1 Remains are Shipped, If Other than Above
Address
2
Ill
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 2/Z Cs."/ / - Registrar of Vital Statistics to CAA6''CL.
(signature)
District Number 5 60 i Place 6 (-Ru-S 7 \\ , dU y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
1,11 yzr Place of Disposition /-'/�')N t -/a441 po
Date of Disposition p i��Z'.� y
2 (ad6ress)
ill
CC (section) /(lot number) (grave number)
ca Name of Sexto r r on in Charge of Premises �r� G4��� �
,2 D (please print)
tEf Signature ti Title G,-e -4 y Ile/ r"
(over)
DOH-1555 (02/2004)