McConnell, Audrey I
11 Al
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
:' Name First Middle Last Sex
. Audrey McConnell Female
ti•!•: Date of Death Age If Veteran of U.S. Armed Forces,
. June 10, 2014 88 War or Dates
iPlace of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death X Natural Cause Accident I I Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Derek Smith
'•: Address
:;:r; 100 Park Street,Glens Falls,NY 12801
Death Certificate Filed District Number RegisrJmber
▪:•:, City, Town or Village Glens Falls 5601
❑Burial Date Cemetery or Crematory
June 11, 2014 Pine View Crematorium
❑Entombment Address
❑x Cremation 21 Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
F' Hold
N
O Date Point of
NI ]Transportation Shipment
3 by Common Destination
Carrier
Disinterment Date Cemetery Address
1-1 Reinterment Date Cemetery Address
:•:.: Permit Issued to Registration Number
::i Name of Funeral Home Regan & Denny Funeral Home 01444
▪r▪ Address
94 Saratoga Avenue, South Glens Falls,NY 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
:; Permission is hereby granted to dispose of the human remains d sscriibbed ov indicated.
Date Issued D(o`//2o/y Registrar of Vital Statistics
j;.; (signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition &lily' Place of Disposition a✓tated C.14*t4olali.--
2 (address)
W
co
O (section) (lo mber) (grave number)
pName of Sexton or Person in Charge of Premises k4L Jews
Z (please print)
W
Signature 4... Title EJ1/r De
(over)
DOH-1555(02/2004)