Ranck, Janet NEW YORK STATE DEPARTMENT OF HEALTH # ZO*7
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
4. Janet Mildred Ranck Female
Date of Death Age If Veteran of U.S. Armed Forces,
00 March 17 2016 82 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls, Street Address The Pines At Glens Falls
Manner of Death n Natural Cause E Accident ❑Homicide n Suicide n Undetermined Pending
MIf Circumstances Investigation
Medical Certifier Name Title
;, Melissa Decker
F1' Address
9 Care Road, I ueensbu ,New York 12804
Death Certificate Filed District Number Register Number
�� City, Town or Village
o /VS
❑Burial Date Cemetery or Crematory
❑Entombment March 18, 2016 Pine View Crematorium
Address
❑x Cremation 51 Quaker Road, Queensbury, NY 12804
Date Place Removed
Z ElRemoval and/or Held
and/or Address
E' Hold
N
0 Date Point of
y ❑Transportation Shipment
p by Common Destination
Carrier
pi Disinterment Date Cemetery Address
—
Reinterment Date Cemetery Address
—
Permit Issued to Registration Number
Name of Funeral Home Re an Penn Stafford Funeral Home 01443
r Address
53 Quaker Road, Queensbury, NY 12804
• Name of Funeral Firm Making Disposition or to Whom
6J• Remains are Shipped, If Other than Above
Address
to
Permission is hereb granted to dispose of the human remains des ribed dove as in. cated.
,r Date Issued �j i7lU�� Registrar of Vital Statistics . ,ti�'
.'% (signature)
f District Number L'SCrra r Place ��`�%
I certify that the remains of the decedent identified above were disposed of in accordance with this ermit on:
Z rumq c
� Date of Disposition 31 7Z lib Place of Disposition 4tt� � o;�,
(address)
W
U)
IX (section) • (lot number) (grave number)
pName of Sexton or Person in Charge of Premises (r431 ,Sr144
Z (please print)
W ��
Signature (f;l Title facattinit
(over)
DOH-1555(02/2004)