Winchell, Darlene NEW YORK STATE DEPARTMENT OF HEALTH ' N. lT to
Vital Records Section Burial - Transit 13ermit
,,, 1 Name First Middle Last Sex
Darlene Ann Winchell Female
f Date of Death Age If Veteran of U.S. Armed Forces,
January 31, 2013 65 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
2 Manner of Death ! Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined n Pending
Circumstances Investigation
Medical Certifier Name Title
,, James North,MD
Address
,Glens Falls,NY
;: Death Certificate Filed District Number Register Number
'' y� VillageGlens Falls,NY 5601 L) '
City, Town or
❑Burial Date Cemetery or Crematory
February 5, 2013 Pine View Crematory
❑Entombment Address
❑x Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z n Removal and/or Held
and/or Address
N Hold
CO
O Date Point of
N ❑Transportation Shipment
'p by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
" Permit Issued to Registration Number
Y t Name of Funeral Home Regan& Denny Stafford Funeral Home 01443
Address
;
f 53 Quaker Road, Queensbury,NY 12804
''? Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
4:;
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 21 1-1 113 Registrar of Vital Statistics L,--) Q1L., .)r--,..3Z.. .A..),..." -rer
(signature)
m f 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:
Z
W Date of Disposition 2- (9-13 Place of Disposition ,,,04.) „lr,,,_
2 (address)
W
N
cc (section) - (lot number (grave number)
t
Op Name of Sexton or Person in Charge f Premises r,.-)-y_�L 0"4
Z I (please print)
W Signature 41x_ �ETitle Cr� id IC
(over)
DOH-1555(02/2004)