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Tallini, Pearl NEW YORk STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex pearl A Tallini Female Date oath Age If Veteran of U.S.Armed Forces, I. ,) li't. 7, 2-0i3 86 War or Dates Mt) 2 Place of Death Hospital, Institution or W City,Town,or Village Glens Falls Street Address Glens Falls Hospital G Manner of Death 'Natural Cause ❑Accident ❑Homicide Suicide ❑Undetermined ❑ Pending W Circumstances Investigation Medical Certifier Tame Title Q Addre Death Certificate Filed District Number ,IV�J 1 / Register Number City,Town or Village Glens Falls 4 1 ❑Burial Date Cemetery or Crematory January 30, 2013 Pineview Crematorium ❑Entombment Address ®Cremation Town of Queensbury Queensbury, NY 12804 2 Date Place Removed 0 ❑Removal and/or Held and/or' Address Hold 0 Date Point of 0 ❑Transportation Shipment d by Common Destination Carrier Date Cemetery Address 8 ❑Disinterment II]Renterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Jillson Funeral Home, Inc. 00885 Address 46 Williams Street, Whitehall, New York 12887 ~ Name of Funeral Firm Making Disposition or to Whom 2 Remains are Shipped, If Other than Above CC W Address O. Permission is hereby granted to dispose of the human remains descri ed abov s in ed. Date Issued ©//�y 0/3 Registrar of Vital Statistics ,4 J / (signature) District Number �£yO/ Place Glens Falls,New York t- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z w Date of Disposition 01/30/2013 Place of Disposition Pineview Crematorium g (address) W N 0 (section) (lot number) C 'f (grave number) O Name of Sexton or Person in Charge of P emises (E,,} r siennil' 2 (pase print) W Signature4 Title Ca661i TY'L (over) 1 DOH-1555 (02/2004)