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Cottone, Judith NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit V. Name First Middle Last Sex ., Judith A. Cottone Female -"; Date of Death Age If Veteran of U.S. Armed Forces, November 17, 2016 60 War or Dates '' Place of Death Hospital, Institution or , City, Town or Village Saratoga Springs Street Address Saratoga Hospital Manner of Death n Natural Cause ❑Accident n Homicide n Suicide 1-1 Undetermined n Pending Circumstances Investigation Medical Certifier Name Title 4 Derek Smith,MD Address 00. Saratoga Hospital,Saratoga Spring,NY • f Death Certificate Filed District Number Register Number �' City, Village11/21/2016 ;f� Town or �� ( 545 El Burial Date Cemetery or Crematory ❑Entombment November 21,2016 Pine View Crematory Address ©Cremation Quaker Road, Queensbury,NY 12804 Date Place Removed Z n Removal and/or Held Q and/or Address Hold N O Date Point of N ❑Transportation Shipment Q by Common Destination Carrier n Disinterment Date Cemetery Address n Renterment Date Cemetery Address • Permit Issued to Registration Number Name of Funeral Home Regan & Denny Funeral Home 01444 • Address 94 Saratoga Avenue, South Glens Falls, NY 12803 _ O 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 remai ri d ab 'ndicate . 7.1 Date Issued I t\21 '`ts) Registrar of Vital Statistics 1 • (signature) firs: District Number nUi 1 Place rc _,k r i ne EX J I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: u.iZ ,eM�� Date of Disposition ���lj Ilb Place of Disposition CrimoctO(Iu., W (address) co w (section) ii(lot numberL (grave number) Z Name of Sexton or Person in Charge of Premises (Zo b�1 } (p ase print) W Signature -67 Title AtAt`W'/Z (over) DOH-1555(02/2004)