McNairy, Elizabeth 1 Bpi
NEW YORK STATE DEPARTMENT OF HEALTH`Vital Records Section Burial - Transit Permit
iii Name First Middle Last Sex
Elizabeth Farr McNairy Female
"r Date of Death Age If Veteran of U.S. Armed Forces,
:`f:,_ February 18, 2014 96 War or Dates
: s Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
: Manner of Death n Natural Cause ❑Accident n Homicide n Suicide n Undetermined n Pending
Circumstances Investigation
tt Medical Certifier Name Title
Gamal G.Khalifa Dr.
ff Address
r 100 Park St, Glens Falls,NY 12801
Death Certificate Filed District Numbe5601 Register Number
f City, Town or Village Glens Falls 7 5
❑Burial Date Cemetery or Crematory
February 20, 2014 Pine View Crematory
❑Entombment Address
❑x Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
ZZ ❑Removal and/or Held
and/or Address
Hold
N
0 Date Point of
u) Transportation Shipment
p by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
W Permit Issued to Registration Number
::<?' Name of Funeral Home Regan Denny Stafford Funeral Home 01443
r : Address
tr 53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
r: Permission is hereby granted to dispose of the human remains described above as indicated.
�Date Issued "Z./ 19 f [f Registrar of Vital Statistics /l) CA.
(signature)
r District Number 5601 PlaceNg Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Ula Date of Disposition )��J3'M� Place of Disposition ��.e ,ate C ,.
2 (address)
W
U)
re (section) flot number (grave number)
pName of Sexton or Person in Charge of Premises Xir,,I - `]e•..r'�-
W (please print)
Signature 4,.... Title Car, ,??
(over)
DOH-1555(02/2004)