Reed, Robin .i 3/3
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
r r Name First Middle Last Sex
:i :: Robin Reed Female
Date of Death Age If Veteran of U.S. Armed Forces,
;: April 21,2016 61 War or Dates n/a
1. Place of Death Hospital, Institution or
City, Town or Village Northumberland, NY Street Address 10 Mott Road
Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
rr Address
a Death Certificate Filed District Number Register Number
.. City, Town or Village Northumberland, NY
❑Burial Date Cemetery or Crematory
April 25, 2016 Pine View Crematorium
❑Entombment Address
0 Cremation 51 Quaker Road,Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
F Hold
N
O Date Point of
NTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
j;:j Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
vAddress
:� 53 Quaker Road, Queensbury, NY 12804
f Name of Funeral Firm Making Disposition or to Whom
r Remains are Shipped, If Other than Above
Address
Permission is hereby ranted to dispose of the human remains described above as indicated.
Date Issued Registrar of Vital Statistics
::::' (signature)
f;: District Number SLD 3 Place —fih-tekiALtaajj I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition ti f ni/j Place of Disposition A. �.. G~
2 (address)
W
CO
CL (section) dfolial.--
(lot number) (grave number)
Q Name of Sexton or Person in Charge o Premises �h
'Z ( lease print)
Signature Title itt
(over)
DOH-1555(02/2004)