Greene, Eunity NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
r.f Eunity C. Greene Female
f
r:.� Date of Death Age If Veteran of U.S. Armed Forces,
?f April 25, 2014 91 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address Stanton Nursing & Rehab Centre
iii Manner of Death X Natural Cause I I Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
* Medical Certifier Name Title
Roslyn Socolof
Address
::: Stanton NH, 152 Sherman Ave,Glens Falls,NY 12804
i. Death Certificate Filed District Number Register Number
City, Town or Village Queensbury 5657
❑Burial Date Cemetery or Crematory
El Entombment April28, 2014 Pine View Crematorium
Address
0 Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
2 and/or Address
F Hold
CO
O Date Point of
NTransportation Shipment
p' by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
x.: 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
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued -2s -DO( Registrar of Vital Statistics • <<,v.ak --'h-\e.4ks›)\-)
:*:: (signature)
District Number 5657 Place Queensbury
HI certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 11-,j0 /� Place of Disposition � r� �/�� 07.--r''.--)44174/
�
2 (address)
W
r
(section) ��et number) (grave number)
0p Name of Sexton P1so9harge of Premises 6 ,ii d
W (ple se print)
Signature Title (�1`� � f
(over)
DOH-1555(02/2004)