Loading...
Kelly, Katharine NEW YORK STATE DEPARTMENT OF HEALTH 1 Vital Records Section Burial - Transit Permit . Name First Middle Last Sex Katharine Kelly Female Date of Death Age If Veteran of U.S. Armed Forces, February 20, 2017 85 War or Dates n/a Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address The Pines Of Glens Falls • Manner of Death A Natural Cause n Accident piHomicide n Suicide ❑Undetermined n Pending $ ' Circumstances Investigation 'Y Medical Certifier Name Title Gwendolyn Morris-Dickinson,MD Address { 100 Park Street,Glens Falls,NY 12801 Death Certificate Filed District Number Register Number {', City, Town or Village Glens Falls 5601 ) ZL( ❑Burial Date Cemetery or Crematory ❑Entombment February 22, 2017 Pine View Crematorium Address ©Cremation 51 Quaker Road, Queensbury, NY 12804 Date Place Removed Z Removal and/or Held and/or Address P. Hold N o Date Point of N ❑Transportation Shipment p by Common Destination Carrier n Disinterment Date Cemetery Address n Reinterment Date Cemetery Address F: Permit Issued to Registration Number Name of Funeral Home Re an Denn Stafford Funeral Home 01443 • Address • • 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 hereby granted to dispose of the human remains described above as indicated. 1 Date Issued 2 / 2 'I �/7 Registrar of Vital Statistics LIOCJ� v-A,. w.:.r✓ ~ (signature) rt District Number 5601 Place Glens Falls �J v HI certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 2I71 II] Place of Disposition i.Va ,/ ttvnrr}cf,i,.�. 2 (address) W W O (section) (lot number) (grave number) QName of Sexton or Person in Charge f Premises /4,-,l ``•' it*itI Z (rJe_ase print) W /� Signature `t Ai Title /1Z4 MR_ (over) DOH-1555(02/2004)