Gallo, Kerstin ; # to 7
NEW YORK STATE DEPARTMENT OF HEALTH •
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Kerstin Gallo Female
Date of Death Age If Veteran of U.S. Armed Forces,
06/20/2017 88 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitati
Manner of Death J Natural Cause ❑Accident Homicide ❑Suicide Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Gwendolyn Morris-Dickinson PA
Address
170 Warren St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 342
❑Burial Date Cemetery or Crematory
06/22/2017 Pine View Crematory
❑Entombment Address
®Cremation Queensbury, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
El 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 06/22/2017 Registrar of Vital Statistics Men ACurtis E(ectronicaaySigned
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of inaccordance with this permit on:
Date of Disposition (0/2s'17 Place of Disposition Rrsc(,.✓ Q f drAl",/
(address)
(section) (lot number) (grave number)
Name of Sexton or Person in Charge f Premises /'L4 p6,- sa►44f'r
(ple a print)
Signature t TitleIE/+►i -
(over)
DOH-1555 (02/2004)