Krauss, Yvonne 14
NEW YORK STATE DEPARTMENT OF HEALTH
it 111
Vital Records Section Burial - Transit Permit
iiiii Name First Middle Last Sex
Yvonne Krauss Female
Date of Death Age If Veteran of U.S. Armed Forces,
March 25, 2014 77 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death X Natural Cause l Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Michael Borgos MD
Address
161 Carey Road Queensbury,NY 12804
Death Certificate Filed Glens Falls District Numbe5601 Register Number
City, Town or Village 5 6of i L (
❑Burial Date Cemetery or Crematory
March 27, 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
N
0 Date Point of
O.
Transportation Shipment
3 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
SAddress
Ai
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 2 6 (1-f Registrar of Vital Statistics GO C .2 (A)
(signature
District Number 5601 Place Glens Falls nJ
1
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 3iz,lit/ Place of Disposition n,(4J �;,,e ar ,,;
2 (address)
W
U)
CZ 0
(section) dt (lot numb} (grave number)
p Name of Sexton or Person in Charge of Premises ,, ?s,
Z (please print)
W
Signature s Title C aeiti[lif
(over)
DOH-1555(02/2004)