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Towers, Doris NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle . Last Sex Doris L Towers Female Date of Death Age If Veteran of U.S. Armed Forces, 02/03/2015 81 years War or Dates -%tery/1 „P_lage of Death Hospital, Institution or T�(II(r XXX9 X Glens Falls Street Address Glens Falls Hospital Glens Falls, N Y 12801 ner of Death Natural Cause 0 Accident 0 Homicide El Suicide El Undetermined El Pending W Circumstances Investigation Medical Certifier Name Title L Michael Fuller M D Address 100 Park Street, Glens Falls, N Y 12801 th Certificate Filed District Number Register Number :it Til6XCXCXr X X iX Glens Falls 5601 67 Burial Date Cemetery or Crematory 02/05/2015 Pine View Cemetery ❑Entombment Address (Cremation Queensbury, NY 12804 Date Place Removed Z n Removal and/or Held 9 and/or Address fU Hold ) 0 Date Point of 0 Q Transportation Shipment G by Common Destination Carrier Disinterment Date Cemetery Address Q Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home, Inc. 00448 Address 7 Sherman Ave. Corinth, NY 12822 Riii Name of Funeral Firm Making Disposition or to Whom -. Remains are Shipped, If Other than Above 2 Address c Lu ©.. Permission is hereby granted to dispose of the human remains desc b abo e a cated. Date Issued 02/05/2015 Registrar of Vital Statistics . (signature) District Number 5601 Place Glens Falls :::::: I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 7[ 6 Place of Disposition Z L, Cr^�o�- l� Date of Disposition �Vti5' p v- 2 (address) la CC (section) (lot number) (grave number) DName of Sexton or Person in Charge of Premises S`�'"l�{ Z please print) l Signature . Title (?tKrt 4 (over) DOH-1555 (02/2004)