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Conlon, Dori NEW YORK STATE DEPARTMENT OF HEALTH 73 Vital Records Section Burial - Transit Permit Name First Middle Last Sex .:„. Dori L. Conlon Female try' Date of Death Age If Veteran of U.S. Armed Forces, : March 23, 2015 52 War or Dates 4: Place of Depth Hospital, Institution or City, Town ^r Village Glens Falls Street Address Glens Falls Hospital Manner r` -pith IN. Natural Cause Accident n Homicide Suicide Undetermined n Pending Circumstances Investigation et, Medical Cr rifier Name Title Daniel Way Address HI71►!v, „t h Creek, NY 12853 District Number ! �/ Register Number_ Cit '' la'- Glens Falls rL57- / /�-5r ❑Burial Date Cemetery or Crematory / March 30, 2015 Pine View Crematory ❑Entombs ' Address ©Creme! Jn 121 Quaker Rd., Queensbury, NY 12804 Date- Place Removed and/or Held O_ H d -s en 0 ' Cate Point of a. c T roes: ;r tion Shipment " =a nestination :ate Cemetery Address j r �tc - ,t ate Cemetery Address Per •-) Registration Number Na al H e Alexander-Baker Funeral Home 00037 - A- 3 rrer. 'y'arrensburg, NY 12885 C: . Making Disposition or to Whom f--: Rer •-rip: If Other than Above Ad, a Pe, her ,' granted to dispose of the human remains described above as indicated. r, 3 (2_6/f c Registrar of Vital Statistics `/\--)C 4 (signatul ) Dis 'r 5.6 0./ Place Glens Falls/ RAJ r 1 I cr ` t re as of the decedent identified above were disposed of in accordance with this permit on: w D r D" 3J)//t3 Place of Disposition !��y /C, a..i Cn-0-- Li (address) (section) (lot number) (grave number) Na ` c rson in Charge of Premises , 4 ' °(please print) : Sir u'_ G'� Title (.1z Pik_ (over) 1 DC-1 :)