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Hoag, Cora NEW YORK STATE DEPARTMENT OF HEALTH M D Burial - Transit Permit Vital Records Section �� {ref Name First Middle Last Sex it Cora Mae Hoag Female .. f Date of Death Age If Veteran of U.S. Armed Forces, September 6,2013 81 War or Dates is Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death j Natural Cause 0 Accident rilHomicide n Suicide El Undetermined n Pending Circumstances Investigation Medical Certifier Name Title t.'`, Dr Coppins,MD lf.. `, Address M. Glens Falls,NY r Death Certificate Filed District Number R9Rister Number ,. �y�� City, Town or Village Glens Falls,NY 5601 ❑Burial Date Cemetery or Crematory ❑Entombment September 16, 2013 Pine View Crematorium Address ©Cremation 21 Quaker Road, Queensbury,NY 12804 _ Date Place Removed C0 Removal and/or Held and/or Address f" Hold Cl) 0 Date Point of N a. ❑Transportation Shipment p by Common Destination Carrier n Disinterment Date Cemetery Address n Reinterment Date Cemetery Address Permit Issued to Registration Number w. Name of Funeral Home Regan & Denny Funeral Home 01444 W Address 94 Saratoga Avenue, South Glens Falls,NY 12803 oi 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 described bo as ' i ted. y A'f; Date Issued 0,/G�`j� � Registrar of Vital Statistics ,r, (signature) l • 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 911(413 Place of Disposition gudiduol C c#ur«.. W (address) CO CL Z Name of Sexton or Person in Charge of Pre ises (section) (lot number)S (grave number) W (ease print) Signature AL Title / 4 (over) DOH-1555(02/2004)