Mingo, Jeanne ' L t/S
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle - Last Sex
Jeanne M. Mingo Female
Date of Death Age If Veteran of U.S. Armed Forces,
08/29/2016 50 years War or Dates
I-- Place of Death Hospital, Institution or
City, TcXj X 4842XXX Glens Falls Street Address 425 Glen Street
a Manner of Death❑ Natural Cause 0 Accident El Homicide 0 Suicide Undetermined Pending
US Circumstances Investigation
ill Medical Certifier Name Title
Timothy E. Murphy Coroner
Address
52 Haviland Ave Glens Falls, N Y 12801
.Death„Certificate Filed. District Number Register,NUmber.. . .,
• City,-TAM(\XW1 X Glens Falls 5601 439
['Burial Date Cemetery or Crematory
08/31/2016 Pine View Crematorium
❑Entombment Address
[Cremation Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
Q❑and/or
Address
CA Hold
O Date Point of
N❑Transportation Shipment
by Common Destination
Carrier
Li Disinterment
Date Cemetery`Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Edward L. Kelly Funeral Home 00519
Address
Schroon Lake, N Y 12870
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
2 Address
CC
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/30/2016 Registrar of Vital Statistics i.")cAdyv t
(sP nature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with
with this permit on:
ILI Date of Disposition 9(31 1(( Place of Disposition avAetc..
(address)
{/)
(section) (lot tuber) (grave number)
pName of Sexton or Person in Charge of Premises .Ji-nth
Z (please int)
Signature A Title ntrY4Kat,
(over)
DOH-1555 (02/2004)