Figgs, Dorothy C • r'T # 7-1
S.
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Dorothy W. Figgs Female
• Date of Death Age If Veteran of U.S. Armed Forces,
March 28, 2016 96 War or Dates NA
'''',,'i Place of Death Hospital, Institution or
City, Town or Village Glens Falls, NY Street Address The Pines At Glens Falls
Manner of Death ❑X Natural Cause ❑Accident ❑Homicide n Suicide n Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Melissa Decker MD
Address
9 Carey Rd. Queensbury,NY
Death Certificate Filed District Number c0 1 Register Number
City, Town or Village Glens Falls, NY 1
❑Burial Date Cemetery or Crematory
March 30 2016 Pine View Crematorium
El Entombment Address ,
11 Cremation 51 Quaker Road, Queensbury,NY 12804
Date Place Removed
Z U Removal and/or Held
and/or Address
H Hold
Cl)
0 Date Point of
N ❑Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
: Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury, NY 12804
%- Name of Funeral Firm Making Disposition or to Whom
1': Remains are Shipped, If Other than Above
Address
Permission is her by ranted to dispose of the humT remain described above a n cated.
Date Issued Q Registrar of Vital Statistics
signature)
<, District Number 5'f�o( Place A—C___g4
I certify that the remains of the decedent identified above ere disposed of in accordant with this permit on:
W Date of Disposition 1'i //6 Place of Disposition 2,,,t,Utj (fir
2 (address)
W
co
cc (section) d (lotnumber) (grave number)
ap Name of Sexton or Person in Charge of P emises OS
Z (pl ase print
W Signature C( Title (1104t0 n A
(over)
DOH-1555(02/2004)