Schumann, Jean tig$
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
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- Name First Middle Last Sex
,.
r:: Jean Marion Schumann Female
m.
,< Date of Death Age If Veteran of U.S. Armed Forces,
s`'`< July 6, 2016 89 War or Dates
-, Place of Death Hospital, Institution or
City,Town or Village South Glens Falls Street Address 8 Harrison Avenue,Apartment 1
Manner of Death D Natural Cause IE Accident 0 Homicide n Suicide n Undetermined n Pending
Circumstances Investigation
Medical Certifier Name Title
Thomas Portuese
f
? Address
` 100 Broad Street,Glens Falls,NY 12801
`? Death Certificate Filed District Number Register Number
,,. City, Town or Village South Glens Falls 4524
,«.ram
❑Burial Date Cemetery or Crematory
❑Entombment July 8, 2016 Pine View Crematorium
Address
®Cremation 51 Quaker Road, Queensbury,NY 12804
Date Place Removed
z• ❑Removal and/or Held
and/or Address
E Hold
(I)
O Date Point of
NElTransportation Shipment
aby Common Destination
Carrier
Disinterment Date Cemetery Address
El
Reinterment Date Cemetery Address
`"'` Permit Issued to Registration Number
:. Name of Funeral Home Regan Denny Stafford Funeral Home 01443
a..� 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 rema' s described abo as indicated.
Date Issued 7)&1I b Registrar of Vital Statistics Aa dy
r, (signature)
District Number 4524 Place South Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 7J it it Place of Disposition R111. L✓ `�. q4w
2 (address)
W
CO
0 (section) 4(,loft number) (grave number)
QName of Sexton or Person in Charge of Premises /M5fl S1P1IL
Z (phhase print)
W Signature a TitleM,Ylif
(over)
DOH-1555(02/2004)