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Charon, Verna _W YORK STATE DEPARTMENT OF HEALTH E is J v� 4tal Records Section Burial - Transit Permit Last Name First Middle Sex Verna Mae Charon Female Date of Death Age ' If Veteran of U.S. Armed Forces, July 19,2011 61 War or Dates 4= Place of Death Hospital, Institution or ° City, Town or Village Glens Falls Street Address Glens Falls Hospital cs, Manner of Death I XI Natural Cause r ]Accident I I Homicide Suicide Undetermined Pending till Circumstances Investigation Medical Certifier Name Title Daniel Way MD Address Warrensburg Health Ctr. Warrensburg,NY 12885 Death Certificate Filed Glens Falls District Number Register Number City, Town or Village 5601 -3 " .. ) ❑Burial Date Cemetery or Crematory ❑Entombment July 21,2011 Pine View Crematorium Address ©Cremation 21 Quaker Road, Queensbury,NY 12804 Date Place Removed Z Removal and/or Held and/or Address E' Hold co 0 Date Point of 351 I Transportation , Shipment 'p by Common Destination Carrier — Disinterment Date Cemetery Address n Reinterment Date Cemetery Address ;: Permit Issued to Registration Number Name of Funeral Home Regan & Denny Funeral Home 01443 Address 53 Quaker Road,Queensbury,NY 12804 Name of Funeral Firm Making Disposition or to Whom tii Remains are Shipped, If Other than Above 2. Address te Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 7,2:21 i j Registrar of Vital Statistics v,) (s nature) o District Number 5601 Place Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z 11.1 Date of Disposition 1/L1,114 Place of Disposition PIN(1uv r�y.ni.1,/,.� W (ad ress) CO fY (section) (lot num ) (grave number) ca Name of Sexton or Pers n in Charge o Premises a-,,„1^er irctfr Z (please print) 11.1 Signature /4/u., Title E'(t y,✓}70(1- (over) DOH-1555(02/2004)