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Castellano, Dolores
}; t 46 Ti NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit ` , Name First Middle Last Sex 0Dolores A. Castellano Female =7 : Date of Death Age If Veteran of U.S. Armed Forces, "% September 21, 2015 95 War or Dates ,f Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death Natural Cause Accident LiHomicide n Suicide n Undetermined n Pending Circumstances Investigation Medical Certifier Name Title James North M.D. ,.,, Address 100 Broad Street,Glens Falls,NY 12801 J) Death Certificate Filed District Number Register Number %>A City Town or Village 5 60 ( LI 6 9 ❑Burial Date Cemetery or Crematory ID Entombmen t September 21,2015 Pine View Crematorium Address ©Cremation Quaker Road, Queensbury, NY 12804 Date Place Removed ZZ C Removal and/or Held and/or Address H Hold N 0 Date Point of jn Transportation Shipment p by Common Destination Carrier El Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number JName 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 1'"'`' Remains are Shipped, If Other than Above Address -: Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued c( I ZZ I '5 Registrar of Vital Statistics (signatur District Number 5 ( ` Place 6 C9 S \s iv l.� I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z 't t Lu Date of Disposition ` 113/IS Place of Disposition iµIL it•r tQc},►— (address) W Cl) Ce (section) A lot number)) (grave number) QName of Sexton or Person in Char a of Premises L�i Jtr '1 Z (please print) W Signature A Title fitemTha (over) DOH-1555(02/2004)