Greenwald, Concetta NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
• Name First Middle Last Sex
• Concetta E. Greenwald Female
as Date of Death Age If Veteran of U.S. Armed Forces,
November 4, 2012 83 War or Dates n/a
.`...• Place of Death Hospital, Institution or
City, Town or Village Town of Moreau Street Address 8 Iris Ave.
{ Manner of Death IXI Natural Cause I I Accident Homicide Suicide Undetermined Pending
Ut Circumstances Investigation
g Medical Certifier Name Title
• Paul Filion,MD
ti.i Address
';'Glens Falls,NY Ia$01
.? Death Certificate Filed District Number Register Number
City, Town or Village Town of Moreau ' /31'2-- 021
❑Burial Date Cemetery or Crematory
November 8,2012 Pine View Crematory
❑Entombment Address
0 Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
ZZ p Removal and/or Held
and/or Address
H Hold
N
O Date Point of
O.
Transportation Shipment
a by Common Destination
Carrier
1-1 Disinterment Date Cemetery Address
U Reinterment Date Cemetery Address
aoy yr Permit Issued to Registration Number
n: Name of Funeral Home Regan Denny Stafford Funeral Home 01443
:y' Address
• 53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
+, Remains are Shipped, If Other than Above
g Address
g.a
'�• Permission is hereby granted to dispose of the human rem ' s described above
vee as indicated.
Date Issued / /-,5 -12 Registrar of Vital Statistics ,(%Y
). j
(signature)
! District Number 45-iv2. Place Town of Moreau
a;
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition it pi (i 2 Place of Disposition -ed(f.,0414 C "r1 u,. ,
2 (address)
W
(section)CL , ;(lot number) r' if (grave number)
0 Name of Sexton or Person in Charge of Pre • es a f is J C yN
Z AL (please print)
W Signature Title C00214044Ve.
(over)
DOH-1555(02/2004)