Hoffman, Joyce ¶ . 1 it 7 1b
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Joyce A Hoffman F
Date of Death Age If Veteran of U.S. Armed Forces,
11 /25/201 3 67 War or Dates N/A
• Place of Death Cit Glens Falls Hospital, Institution or Glens Falls Hospital
City, Town or Village y- Street Address P
Manner of Death 0 Natural Cause Accident 0 Homicide Suicide Undetermined Pending
W. Circumstances Investigation
La Medical Certifier Name Title
0 William A. Tedesco MD
Address 3 Irongate Center Glens Falls N.Y. 12801
Death Certificate Filed District Numbe���I1i Regber
City, Town or Village
kil OBurial Date Cemetery or Crematory
11 /26/2013 Pine View Crematory
❑Entombment Address
®Cremation Quaker Road Queensbury, NY Rtal
Date Place Removed
❑Removal and/or Held
and/or Address
w= Hold
th
O Date Point of
Di❑Transportation Shipment
a by Common Destination
Wii Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Mason Funeral Home Registration Number
Name of Funeral Home 011 1 7
O Address P.O. Box 277
18 George Street Fort Ann, NY 12827
Wi Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
Cr
;lam
Permission is hereby granted to dispose of the human remains described ove as ind' ate .
Date Issued Registrar of Vital Statistics __e__,,
signature
District Number,..5" j Place ��
i
`' I certify that the remains of the decedent identified above were disposed of in accordance h this permit on:
ILI• Date of Disposition Il- Z113 Place of Disposition uJ.ttti,.) io<
a (address)
lit
CA
(section) timber) ( (grave number)
CI j44Y�Name of Sexton or Person in C rge of Prerr)ises (pl print)
iii fry
Signature 7L - Title alert')
(over)
DOH-1555 (02/2004)