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Cacchione, Donna NEW YORK STATE DEPARTMENT OF HEALTH .r # Z S Vital Records Section Burial - Transitermit Name First Middle Last Sex Donna Cacchione Female Date of Death Age ' If Veteran of U.S. Armed Forces, May 15, 2011 _ 65 War or Dates 1. , Place of Death I Hospital, Institution or Z City, Town or Village Glens Falls Street Address Glens Falls Hospital WManner of Death [XI Natural Cause l Accident Homicide [ I Suicide Undetermined Pending Circumstances Investigation usus Medical Certifier Name Title '© Michael Adams MD Address State Rt 9 South Glens Falls,NY Death Certificate Filed r District Number ' Regi ► u i{per City, Town or Village Glens Falls 5601 • d ❑Burial ! Date Cemetery or Crematory May 18, 2011 Pine View Crematorium ❑Entombment Address EX Cremation 21 Quaker Road,Queensbury, NY 12804 _ Date Place Removed Z f 'Removal and/or Held O and/or Address Hold Cl) 0 _ Date Point of a TransportationShipment N p a by Common Destination Carrier 1 Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan& Denny Funeral Home j 01464 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 Z W ` _ — a. Permission is her by granted to dispose of the human r ains described ab e as ind' ated. Date Issued Registrar of Vital Statistics (signature) District Number 5601 Place Glens Falls I certify that the remains of the decedent identified above we disposed of in accordance with this permit on: W Date of Disposition c-15-t( Place of Disposition .12M IA) Crw.e(o r to, Ili (address) CO (Y (section) (lot number- (grave number) p Name of Sexton or Pe son in Charge f Premises tk f,s oplir '��c� 'Z (please print) Signature Title L1t Mbi-(,(; (over) DOH-1555(02/2004)