Turnbull, Florence NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit ermit
:: Name First Middle Last Sex
Florence L. Turnbull Female
;rf Date of Death Age If Veteran of U.S. Armed Forces,
frr October 23, 2015 97 War or Dates
r Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address 179 Sunnyside Road
Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
: Medical Certifier Name Title
:e: Donald Merrihew,MD
k:::; Address
..319 Bay Road,Queensbury,NY 12804
.%%:. Deat 'ficate File ict Number R9gister Number
,, ,
City Town r Village ( S . (�.c
❑Burial Date Cemetery or Crematory
October 26, 2015 Pine View Crematorium
❑Entombment Address
❑x Cremation 21 Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
Hold
N
0 Date Point of
EL
Transportation Shipment
a by Common Destination
Carrier .
Disinterment Date Cemetery Address
n Reinterment
Date Cemetery Address
;: Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
r:: Address
53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
i°.°: Remains are Shipped, If Other than Above
Address
' x Permission is hereby granted to dispose of the human r ains described a ove as Indicated.
Date Issued IO o::l_s) bthcRegistrar of Vital Statistics C._ _ Q >���
®::: (signature)
i—
;; District Number S(9�n Place ) 0(_„____I-.N. C)4 ('')_.
I certify that the remains of the decedent identified above were disposed of in accor.. ith this permit on:
W Date of Disposition /Dint(5" Place of Disposition Rite(k. Cftwelora.,
2 (address)
W
U)
p0 (section) (lot num�r) (grave number)
Name of Sexton or Person in Charge of Premises rift:, J[af'(
Z (please print)
,..
di Signature Title (( e: 17/.
(over)
DOH-1555(02/2004)