Duff, Carol NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
;ice Name First Middle Last Sex
:: Carol Ann Duff Female
Date of Death Age If Veteran of U.S. Armed Forces,
April 22,2016 74 War or Dates n/a
Place of Death
i Hospital, Institution or
City, Town or Village Lake George Street Address 76 D Sewell Street
Manner of Death Medical Certifier
X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Name Title
0 William Tedesco,MD
Address
,;.®f Glens Falls,NY
:F. Death Certificate Filed District Number Register Number
City, Town or Village Lake George,NY 5620
❑Burial Date Cemetery or Crematory
April 25, 2016 Pine View Crematorium
E.Entombment Address
Ei Cremation 51 Quaker Road, Queensbury,NY 12804
Date Place Removed
Z I I Removal and/or Held
and/or Address
Hold
0 Date Point of
Q.
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
F° "® 53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
. Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described ove as indicated.
1
0r Date Issued 4 Z- / Registrar of Vital Statistic 7)� 0.4
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(dgnature)
r District Number (��� Place �� y� 4a,...1 c--, / 2-.K/56----
I certify that the remains of the decedent identified above were di osed of in accordance with this permit on:
Z
tu Date of Disposition t/iis(L Place of Disposition ILut+1— Lct ---
2 (address)
W:
N
CC (section) lot number) (grave number)
pName of Sexton or Person in Charge of Premises t Qi st,4
Z (please print)
W a ..4
Title
Signature
(over)
DOH-1555(02/2004)