Biles, Catherine NEW YORK STATE DEPARTMENT OF HEALTH s Burial - Trans Permit
Vital Records Section
Name First Middle Last Sex
Catherine E. Biles Female
Date of Death Age If Veteran of U.S. Armed Forces,
April 6, 2014 98 War or Dates
F, Place of Death Hospital, Institution or
Z City, Town or Village Fort Edward Street Address Fort Hudson Nursing Home
• Manner of Death l Xl Natural Cause Accident [ Homicide i l Suicide 1-7 Undetermined Pending
U1 Circumstances Investigation
AMedical
Certifier Name Title
Address
Death Certificate Filed District Number Register Number
City, Town or Village Fort Edward,NY 5755 33
❑Burial Date Cemetery or Crematory
April 8, 2014 Pine View Crematorium
❑Entombment Address
0 Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
ZO n Removal and/or Held
and/or Address
Hold
N
O Date Point of
n Transportation Shipment
p by Common Destination
Carrier
[1]Disinterment Date Cemetery Address
[i 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
Address
Ot
Permission is hereby granted to dispose of the huma reains described above as indicated.
Date Issued O(-/0�/(Li Registrar of Vital Statistics'( L1
(signature)
District Number 5755 Place Fort Edward,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition y I I Place of Disposition .f: .4 64,,.�.
2 (address)
111
(section) (lot numbed— (grave number)
Z Name of Sexton or Person in Charge of Premises d,tic&L �tt�►
please print)
Signature L_ Title C2If�
(over)
DOH-1555(02/2004)