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Strazza, Racheal t NEW YORK STATE DEPARTMENT OF HEALTH fl 70 Vital Records Section Burial - Transit Permit Name First Middle Last Sex echael- R.ACA G'�L C. Strazza Female Date of Death Age If Veteran of U.S. Armed Forces, November 23, 2013 84 War or Dates i_ Place of Death Hospital, Institution or Z City, Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death 0 Natural Cause ❑Accident ❑Homicide 0 Suicide n Undetermined n Pending W Circumstances Investigation W Medical Certifier Name Title G Darci Galetti-Grubbs MD Address 102 Park Street,Glens Falls,NY 12801 Death Certificate Filed District Number Register Number n City, Town or Village Glens Falls 5601 41 of ❑Burial Date Cemetery or Crematory November 25, 2013 Pine View Cemetery ❑Entombment Address ❑x Cremation Quaker Road, Queensbury, ,NY 12804 Date Place Removed ZZ n Removal and/or Held and/or Address H Hold CO 0 Date Point of N ❑Transportation Shipment p by Common Destination Carrier n Disinterment Date Cemetery Address n Renterment 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 I- Remains are Shipped, If Other than Above 2 Address CL a Permission is he eby ranted to dispose of the human remains cribed above as ind Gated. Date Issued i/ , ie i. Registrar of Vital Statistics ©[. `i'at r 4 �� (signature) District Number 51 Place Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: w Date of Disposition tt-1(03 Place of Disposition Fryiva ( c"( c_ 2 (address) W U) re (section) (lot number) j'� (grave number) QName of Sexton or Person in arge of Premises �rra J+ Z (plea a print) W gMEMY4 O Signature i J,_ Title (over) DOH-1555(02/2004)