Richards, Friedariche Scl -
NEW YORK STATE DEPARTMENT OF HEALTH N.
Vital Records Section Burial - Transit Permit
• Name First Middle Last Sex
Friedariche W. Richards Female
Date of Death Age If Veteran of U.S. Armed Forces,
August 23,2013 91 War or Dates
[ Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death a Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
u{ Medical Certifier Name Title
Addees
Death Certificate Filed �� District Number Rester tuber
City, Town or Village Glens Falls,NY 5601 ��
❑Burial Date Cemetery or Crematory
August 26,2013 Pine View Crematory
❑Entombment Address
®Cremation Quaker Road, Queensbury,NY
Date Place Removed
ZZ El Removal and/or Held
2 and/or Address
H Hold
U)
O Date Point of
N0 Transportation Shipment
p by Common Destination
Carrier
0 Disinterment Date Cemetery Address
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
Permission is hereby granted to dispose of the human remains describ /d�abboove a ind- a .
• Date Issued ()8 Z6/ZU,l3 Registrar of Vital Statistics '
(signature)
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:
w Date of Disposition 6-d1--13 Place of Disposition TAN a_ VI f_J ea."4- *..-�c
(address)
W
Cl)
CZ (section) (l0ty�urober) (grave number)
pName of Sexton o Pers in r of Premises 5� f� Ke \\
Z (please printi
7
W Signature Title G �A-9 d lc..
(over)
DOH-1555(02/2004)