Paniccia, Janet NEW YORK STATE DEPARTMENT OF HEALTH ��
Vital Records Section k Burial - Transit Permit
r : Name First Middle Last Sex
'ff? Janet R. Paniccia Female
e?
Date of Death Age If Veteran of U.S. Armed Forces,
'r�:' October 18, 2014 79 War or Dates
1Y:ti�
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Ali Circumstances Investigation
Medical Certifier Name Title
r: Joseph C.Minhindu Dr.
Address
:: 20 Murray Street,Glens Falls,NY 12801
1 Death Certificate Filed District Number Register Num
jj be/r1''
s City, Town or Village Glens Falls 5601 `� W
❑Burial Date Cemetery or Crematory
October 20, 2014 Pine View Crematorium
❑Entombment Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
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O Date Point of
NTransportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
;r; Address
407 Bay Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
;f::: Permission is hereby granted to dispose of the humremains escribed above as in. cated
::; Date Issued D Registrar of Vital Statistics "_- I 1--
N.:. (sig ature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above w re disposed of in accordance with this permit on:
Z �^
Date of Disposition (o/z311ti Place of Disposition Zhu. C.rsiic to
W (address)
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Ce
0 )(section /,�(lot numb (grave number)Q Name of Sexton or Person in Charge of Premises Gtir,‘ oi
Z (pl ase print)
W Signature �� Title fr1.vt*&Urt..
(over)
DOH-1555(02/2004)