Stiles, Alice •
NEW YORK STATE DEPARTMENT OF HEALTH .1 ' 2toZ
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Alice Stiles Female
Date of Death Age If Veteran of U.S. Armed Forces,
, April 3, 2015 90 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death ❑X Natural Cause ❑Accident Homicide n Suicide ❑Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
0 Daniel Larson,MD
Address
Glens Falls,NY
Death Certificate Filed District Number Register tuber
City, Town or Village Glens Falls,NY 5601
❑Burial Date Cemetery or Crematory
April 8,2015 Pine View Crematorium
❑Entombment Address
II Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z I—I❑Removal and/or Held
and/or Address
H Hold
N
Q Date Point of
NE Transportation 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
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 `I l'I) I i. Registrar of Vital Statistics LA)C.". "0 " L.A1.)- `
kIt
(sign ure)
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tu Date of Disposition t(C'(pr Place of Disposition ;P EL L, ;�
(address)
W
Cl)
Ce (section) 9 (lot nur) (grave number)
cp Name of Sexton or Person in Charge of Premises 1,4,, r-
Z (please print)
Signature A Title a2Et;
(over)
DOH-1555(02/2004)