Dingman, Sheila a
ii 3s1
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
:::: Name First Middle Last Sex
:::-:a Sheila E. Dingman Female
:: Date of Death Age If Veteran of U.S. Armed Forces,
°fir May 28,
i2014 67 War or Dates
.-;q Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital 1
gi Manner of Death X Natural Cause 1 !Accident Homicide Suicide { Undetermined Pending
Circumstances Investigation
j3 Medical Certifier Name Title
ice. Ageel Gillani, MD
Address
:;:: 100 Park Street, Glens Falls,NY 12801
:_:®: Death Certificate Filed District Number Register Number
C:;;: City, Town or Village Glens Falls,NY 5601 -- ..5
❑Burial Date Cemetery or Crematory
May 30, 2014 Pine View Crematorium
❑Entombment Address
CI Cremation 21 Quaker Road, Queensbury, NY 12804
Date Place Removed
Z
I. I Removal and/or Held
and/or Address
F Hold
co
0 Date Point of
y1. !Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
'i? Permit Issued to Registration Number
:: Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury, NY 12804
00.
Name of Funeral Firm Making Disposition or to Whom
.. Remains are Shipped, If Other than Above
U. Address
w:-: :::':'::
is her rante to dispose of the human a ains described abov as indicate
r er Y 9 p
::1 J p Registrar of Vital Statistics _,
µ: (signature)
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H ,1 �
Date of Disposition /i 14 Place of Disposition _ g,,.evu.� (,H oc ..
2 (address)
W
U)
(section) t nurr�er (grave number)
pName of Sexton or Person 'n Charge of Premises G/�,ri i �Jtt,,
Z (please print)
W Signature -�' Title CatrnitraL,
(over)
DOH-1555(02/2004)