Stoddard,Antoinette It /Ils
NEW YORKSTATE DEPARTMENT OF HEALTH Burial- Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Antoinette Stoddard Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/11/2020 91 Years War or Dates
Place of Death Hospital,Institution or
W City,Town or Village Granville Town Street Address 405 State Route 22A,Granville Town,New York 12835
pManner of Death Natural Cause El Accident ❑Homicide ❑Suicide I=1 Undetermined n Pending
V
Cirumstenos Investigation
0UJI Medical Certifier Name Title
Thomas Kandora MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Granville 5756 64
❑Burial Date Cemetery,Crematory or Facility Name
10/14/2020 Pineview Crematory
❑Entombment Address
0 Cremation Queensbury Town,New York
El Donation
goRemoval Date Place Removed
and/or and/or Held
F Hold Address
0
tZ Date Point of
U)❑Transportation
b by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Reg stration Number
Name of Funeral Home John F X Mckeon&Son Inc 00890
Address
3129 Perry Ave,Bronx,New York 10467
Name of Funeral Firm Making Disposition or to Whom
F— Remains are Shipped,If Otherthan Above
`1• Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/14/2020 Registrar of Vital Statistics .jenny Linda 9Kartele(ECectronicatty Signed)
'signature)
District Number 5756 Place Granville, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit or:
W Date of Disposition /Oi/5 176 Place of Disposition
2 /address)
uJ
N
(section) A)tot n rmberl (grave number)
gName of Sexton or Person in Charge o Premises �b�,_)em tit
Z (plea print)
LLl Signature � Title !""""
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) --
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#