Callahan, Joyce NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Hi Name First Middle Last Sex
Joyce M. Callahan Female
Date of Death Age If Veteran of U.S. Armed Forces,
July 04, 2014 77 yrs. War or Dates ' 56— ' 62
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
ILI0 Manner of Death Natural Cause 0 Accident Homicide Suicide Undetermined Pending
l Circumstances Investigation
ill Medical Certifier Name Title
0
DaX !esoote, MD.
Main St. , Hudson Falls, NY. 12839
Death Certificate Filed District Number Reg4 to umber
City, Town or Village Glens Falls 5601 0
11❑Burial Date Cemetery or Crematory
July 07, 2014 PineView Crematorium
iiiiiii ❑Entombment Address
g: ®Cremation Oueensbury, NY.
Date Place Removed
❑Removal and/or Held
and/or Address
E: Hold
)
Date Point of
Transportation Shipment
G by Common Destination
iiiS Carrier
❑Disinterment Date Cemetery Address
g:iii❑Reinterment Date Cemetery Address
Permit Issued to Mason Funeral Home Registration Number
Name of Funeral Home
niiii
ni Address
18 George St. , Fort Ann, NY. 12827
ipii Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
lI
'` Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/0 7/2 01 4 Registrar of Vital Statistics LJ CNlYy\.R.W
(signature
iiiiiIiiii District Number 5601 Place City of Glens Falls, NY.
>:: I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ill Date of Disposition 1-g-11 Place of Disposition • Vew Ctwt/tof juA
(address)
Itit
CC (section) / (lot number) (grave number)
its Name of Sexton or Person i Charge of Premises Oat- . 4+VII
(p ase print)
11,4 Signatures Title Cl11
oii
(over)
DOH-1555 (02/2004)