Irving, Valerie 991
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Valerie Joan Irving Female
Date of Death Age If Veteran of U.S. Armed Forces,
12/25/2017 85 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Queensbury Town Street Address Westmount Health Facility
Manner of Death X❑Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined 17❑Pending
Circumstances Investigation
Medical Certifier Name Title
Roslyn Socolof MD
Address
42 Gurney Ln,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City, Town or Village Queensbury 5657 165
El Burial Date Cemetery or Crematory
12/29/2017 Pine View Crematory
❑Entombment Address
Cremation Queensbury, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 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.
Date Issued 12/27/2017 Registrar of Vital Statistics Carohne7CBar6er ElectronicalySigned
(signature)
District Number 5657 Place Queensbury, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 1 Z/zq�/7 Place of Disposition fFr QJ7& �/'t--4.,
j (address)
(section) (lot number) (grave number)
Name of Sexton r_P f on in Charge of Premises . J i� /i L?�i-r✓ =v
/ (please print
Signature + :: f/ Title G(Vey-t-ram
(over)
DOH-1555 (02/2004)