Denno, Shirley NEW YORK STATE DEPARTMENT OF HEALTH r • Sqg
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Shirley Beatrice Denno Female
Date of Death Age If Veteran of U.S. Armed Forces,
August 8, 2015 80 War or Dates
F- Place of Death Hospital, Institution or
w City, Town or Village Kingsbury Street Address 10 Moss Street Square
;
WManner of Death X❑ Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
W Medical Certifier Name Title
Ci Joseph Foote MD,
Address
Rt 4 Hudson Falls, NY 12839
Death Certificate Filed District Number Register Number
City, Town or Village 5 7 6 01 /02-
❑Burial Date Cemetery or Crematory
August 14, 2015 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ❑ Removal and/or Held
and/or Address
R. Hold
CO Date Point of
aC Transportation Shipment
CO by Common Destination
❑'` Carrier
Date Cemetery Address
El Disinterment
❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
I- Remains are Shipped, If Other than Above
M Address
CC
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued -// -,ZO/S Registrar of Vital Statistics
(signature)
District Number s 76 Place Yatvh G h1S b vr-ci
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 08/14/2015 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
W
co
ce 0 (section) (lot number) (grave number)
p Name of Sexton or Person in Charge of Premises,
Iris 3;100
( ease print)
W Signature Title wlrp;�
(over)
DOH-1555 (02/2004)