Garside, Frances # 630
NEW YORK STATE DEPARTMENT OF HEALTH to , ,Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Frances R. Garside Female
Date of Death Age If Veteran of U.S. Armed Forces,
November 29, 2012 I 90 War or Dates
:k= Place of Death Hospital, Institution or
Z City, Town or Village Saratoga Springs , Street Address Saratoga Hospital
0 Manner of Death I XI Natural Cause [ I Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
u Medical Certifier Name,- 1 I� Title
P. w i bt;Avv\ • V i OD et.nCv' Nib -
,
Address
Death Certificate Filed District Number ` Register Number
I- b City, Town or Village Saratoga Springs,NY I a
❑Burial Date Cemetery or Crematory
December 3, 2012 Pine View Crematory
Entombment Address
❑x Cremation Quaker Road, Queensbury, NY 12801
Date Place Removed
ZZ I I Removal and/or Held
and/or Address
H Hold
CO
0 Date Point of
O.
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
iN+ Remains are Shipped, If Other than Above
a Address
rz
us
rrk Permission is hereby granted to dispose of the human remains 'be aboysos i icated.
Date Issued /00 Ok.2... Registrar of Vital Statistics
(signature)
.i District Number 4/1-0/ Place Saratoga Springs,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 12 I1 I L Place of Disposition ZUko..) C' of:o.-
2 (address)
w
co
O (section) AC
- lot number) (grave number)
p Name of Sexton or Person in Charge of Premises ;P� So^tilt
Z IlL (please print)
W 9 Si nature Title ME riccOi ,
(over)
DOH-1555(02/2004)