Schneider, Carol # sy
NEW YORK STATE DEPARTMENT OF HEALTH.'
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
ii Carol J. Schneider Female
Date of Death Age If Veteran of U.S. Armed Forces,
January 24, 2015 73 War or Dates n/a
Place of Death Hospital, Institution or
City, Town or Village Glens Falls, NY Street Address Glens Falls Hospital
Manner of Death X Natural Cause I !Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Fl Scott Biasetti,MD
:j Address
Glens Falls,NY
Death Certificate Filed District Number Register Number
▪ City, Town or Village Glens Falls,NY 5601 C—t 0
❑Burial Date Cemetery or Crematory
El Entombment January 26, 2015 Pine View Crematorium
Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
W
O Date Point of
NTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
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
i.*: Name of Funeral Firm Making Disposition or to Whom
,* Remains are Shipped, If Other than Above
ii Address
▪ Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued V 1 2 / 1S Registrar of Vital Statistics LA)OLA.k
(sign
District Number 5601 Place Glens Falls,NY
F- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition I--27-Is' Place of Disposition 0,..L („r.. rL.
2 (address)
W
CO
CC (section) (lot number (grave number
pName of Sexton or Person in Charge of Premises dr4 At..v�j-' )
Z (p ase print)
W4Signature �,� Title 4101
(over)
DOH-1555(02/2004)