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McDowell, Janet Z_ IS NEW YORK STATE DEPARTMENT OF HEALTH - 4 Vital Records Section Burial - Transit Permit fire: Name First Middle Last Sex ,• t Janet Estabrooks McDowell Female ,f; Date of Death Age If Veteran of U.S. Armed Forces, C May 18,2013 97 War or Dates n/a f:r:r Place of Death Hospital, Institution or • City, Town or Village Queensbury Street Address Stanton Nursing& Rehab Centre Manner of Death l)(l Natural Cause n Accident n Homicide n Suicide Undetermined Pending Circumstances Investigation Medic Certifier Name Title r�_� r• �S1 � �� Yin '.. dress. iffy 0.-kA-Q_LC\-36-k-ti11 Death Certificate Filed ' District Number Register Number • City, Town or Village Queensbury,NY 5657 ILO ❑Burial Date Cemetery or Crematory May 20,2013 Pine View Crematory ❑Entombment Address ©Cremation Quaker Road, Queensbury,NY 12804 Date Place Removed Z n Removal and/or Held and/or Address F"` Hold N O Date Point of N n Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address n Reinterment Date Cemetery Address a Permit Issued to Registration Number z• Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address ri 53 Quaker Road,Queensbury, NY 12804 ;fir 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 describe above as indicated. ':',N. 4S) ac�i c)Ql Registrar ��.Q 1 'f Date Issue of Vital Statistics r�r (signature) of District Number 5657 Place Queensbury,NY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 3a k� Place of Disposition NL \/ (� M94c 2 (address) W r' (section). -a' of number) (grave number) QName of Sexto 'or e •on in C arge of Premises t,L./ C Z (please print) us �� U Signature ' � Title ��%(��$�ry C (over) DOH-1555(02/2004)