Casey, Sandra NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
ro: Name First Middle Last Sex
Sandra Leeann Casey Female
Date of Death Age If Veteran of U.S. Armed Forces,
rf November 26, 2015 75 War or Dates
iPlace of Death Hospital, Institution or
City, Town or Village Glens Falls, NY Street Address The Pines of Glens Falls
Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
,......*
Medical Certifier Name Title
r a Address
i.;.•e. Death Certificate Filed District Number Regis Nu ber
.f•f �
;r City, Town or Village Glens Falls,NY 5601 �
❑Burial Date Cemetery or Crematory
November 30, 2015 Pine View Crematorium
❑Entombment Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z ❑Removal and/or Held
® and/or Address
F Hold
O Date Point of
u) Transportation Shipment
G by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
f.ae
Permit Issued to Registration Number
r Name of Funeral Home Regan & Denny Funeral Home 01444
*i:' Address
••r:e 94 Saratoga Avenue, South Glens Falls, NY 12803
r;r Name of Funeral Firm Making Disposition or to Whom
i Remains are Shipped, If Other than Above
Address
'.:.'�•`.• Permission is herebyranted to dispose of the human remains describe above a icated.
ii3: p �C L/
��'� Date Issued ll 27 Zpl,� Registrar of Vital Statistics
'rr (signature)
.; : District Number �6 0/ Place �� '�/S/j�
/ /V
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z p J Place of Disposition IF.,/ ( - 'foru,✓
W Date of Disposition 2 1 �/� p
2 (address)
W
Cl)
rt (section) Not number) (grave number)
pName of Sexton or Person in Charg: of Premises irs,v. Sint
Z / (pl ase print)
Signature , AA.., Title n264404-
(over)
DOH-1555(02/2004)