Gilson, Cathryn NEW YORK STATE DEPARTMENT OF HEALTH Du7) 1
Vital Records Section ' , Burial - Transit Permit
Name First Middle Last Sex
n::) Cathryn A. Gilson ) Female
:.: Date of Death Age If Veteran of U.S. Armed Forces,
May 18,2012 80 War or Dates
i.y' Place of Death I Hospital, Institution or
City, Town or Village Queensbury I Street Address 16 Knolls Road
a+ Manner of Death f Natural Cause n Accident I Homicide Suicide n Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
LY M A-R-K TE oFC MA-ram ll't 1]
Address
j c 6 z - r k . ( -e_its cLits, KY/ I Z So
,: Death Certificate Filed 1 District Number egister Number
a: City, Town or Village Queensbury I 56574 .p
❑Burial Date , Cemetery or Crematory
5 I a fr 12_ 1 Pine View Crematorium
❑Entombment Address
0 Cremation 21 Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
N
0 Date Point of
Nn Transportation Shipment
p' by Common Destination
Carrier
Disinterment Date ' Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name 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
Remains are Shipped, If Other than Above
il Address
CZ'
US
Permission is hereby granted to dispose of the huma re ains described a e as indicated.
Date Issued l -t leap 0. Registrar of Vital Statistics n-t-p_
(signature)
District Number 5657 Place Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
LLI Date of Disposition s Milt, of Disposition OkVuN, (rr&(lrlvti
W (address)
N
re (section) _ (lot number) (grave number)
pName of Sexton or Person i Charge of Pr ises (h s t i... k. vii+
Z (please print)
W
Signature Title CeE.(n Q.,
(over)
DOH-1555(02/2004)