Bang, Anne , - % # g 7
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Anne Hickey Bang Female
<; Date of Death Age If Veteran of U.S. Armari Fnrr,Ps_.
; , June 24,2016 70 War or Dates ,„ ,--„
,.
Place of Death Hospital, Institution or
City, Town or Vill ge Glens Falls Street Address Glens Falls Hospital
Manner of Death Natural Cause Accident Homicide Suicide Undetermined n Pending
Circumstances Investigation
Medic Certifier ,___ N1a_me Title
(QF tOJlit)tlolit rr
vtirs
;;% Death Certificate Filed i District N tuber Register Number
>>: City, Town or Village Glens Falls 5p 3 Z.
❑Burial Date Cemetery or rematory
❑Entombment June 28, 2016 Pine View Crematorium
Address
®Cremation 51 Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
N
O Date Point of
ND Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
ri 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
,j 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 above as indicated.
Date Issued 4 i 2 7 j L b Registrar of Vital Statistics LC LA4\.-� (
(signature)
District Number 5/90( Place 6 (jv s Ft. . 5 0,)
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 7 + 1 /it Place of Disposition nt U., r L4Ur_
2 (address)
W
re (section) (I t number)C (grave number)
pName of Sexton or Person in Charge of Premises f,s ..)e'^
Z ( lease print)
W /�
Signature !� Title fittriittTlfl
(over)
DOH-1555(02/2004)