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Gregson, Denise NEW YORK STATE DEPARTMENT OF HEALTH E ; 11 2 q Vital Records Section Burial - Transit Permit Name First' Middle Last Sex Denice H. Gregson Female - Date of Death Age If Veteran of U.S. Armed Forces, !°u April 21,2014 57 War or Dates il Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital L5 Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation Y' Medical Certifier Name Title g Jennifer Donovan Address HHFIN,Johnsburg,NY 12843 Death Certificate Filed District Number Register Number •,e:_: City, Town or Village Glens Falls 5601 2 Q 3 ❑Burial Date Cemetery or Crematory April 28,2014 Pine View Crematory 0 Entombment Address ©Cremation 21 Quaker Rd., Queensbury,NY 12804 Date Place Removed Z Removal and/or Held and/or Address H Hold U) aDate Point of N I I Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address <<a Permit Issued to Registration Number ,'.: Name of Funeral Home Alexander-Baker Funeral Home 00037 Address :.. 3809 Main Street, Warrensburg,NY 12885 ::':ii7 Name of Funeral Firm Making Disposition or to Whom :114 Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 1.( (a y /(L i Registrar of Vital Statistics �. ,m: �� (signs re) .`, District Number 5601 Place Glens Falls 1 V k-? I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition Nifilit( Place of Disposition f ttkr C. .tifnr,.--) W (address) N pce (section) � (lot num (grave number) Name of Sexton or Pers in Charge of Premises t;Li R,,,.i/+ Z (please punt) W Signature Z Title Ca r 700. (over) DOH-1555 (02/2004)