Cargin, Janna NEW YORK STATE DEPARTMENT F+HEA&TH
Vital Records Section °, Burial - Transit Permit
p!!Iii Name First Middle Last Sex
Janna Cargin Female
Date of Death Age If Veteran of U.S. Armed Forces,
08 / 19 / 2016 62 War or Dates
Place of Death Hospital, Institution or
ZCity, Town or Village Glens Falls Street Address Glens Falls Hospital
Q Manner of Death®Natural Cause El Accident E Homicide ❑Suicide ri Undetermined Pending
Circumstances Investigation
tli Medical Certifier Name Title
O Farhana Kamal MD
Address
100 Park St, Glens Falls, NY 12801
Death Certificate Filed District NunL?r6 Regist r NOP m er
City, Town or Village Glens Falls Q
Oii Burial Date Cemetery or Cremaftory
® 08 / 22 / 2016 Pine View Crematory
Mi El Entombment Address
3 ii OCremation Queensbury, NY
Date Place Removed
Z❑Removal and/or Held
and/or
Address
V
▪ Hold
Date Point of
Q Transportation Shipment
by Common Destination
Mi Carrier
tiP
Disinterment Date Cemetery Address
—
Reinterment
Date Cemetery Address '
r
Permit Issued to Registration Number
Vii Name of Funeral Home Compassionate Funeral Care i 00364
M Address
Vi 402 Maple Ave. Saratoga Sp. NY 12866
Mi Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
t
:-`::i: Permission is here y g anted to dispose of the human 7descnbed bovas iliai
S'11.1 District Number 3 Place alls , New York
• I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
til Date of Disposition ZZI/LP Place of Disposition iii 2- U rapt) Gre- ia.�r,'
in
/ (address)
cc (section) t (lo umber) (grave number)
C Name of Sexton er n iPcharge of Premises V.t,,,1 i C,/t v✓l0Lti-t
Z (please print)
10
Signature Title C--re_r✓z-.4.710
(over)
DOH-1555 (02/2004)