Giguere, Sylvia _4 % # 2(q0
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Sylvia Giguere Female
Date of Death Age If Veteran of U.S. Armed Forces,
`''`` April 26, 2013 92 War or Dates
}, Place of Death Hospital, Institution or
oCity, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death ❑Natural Cause ❑Accident ❑Homicide ❑Suicide Undetermined n Pending
Circumstances Investigation
hu
Medical Certifier Name Title
Dl-vz0 5C-P3G IcAI PIZ
Address
b0 4.,k 51' Cit,,5 P; C N�„ (no'
Death Certificate Filed 111 District Number ' Regisr�Number
City, Town or Village Glens Falls 5601 I lb
❑Burial Date Cemetery or Crematory
April 29,2013 Pine View Crematory
❑Entombment Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z ElRemoval and/or Held
and/or Address
H Hold
N
O Date Point of
N ❑Transportation Shipment
p by Common Destination
Carrier
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
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• Permission is hereb gr nted to dispose of the human remains descr'b d ov as i ted.
Date Issued 0 51'29 /3 Registrar of Vital Statistics
(signature)
District Number 5601 Place City of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 4-3013 Place of Disposition 4 Q(, J rwr•c'tp(Zw
2 (address)
W
Lg (section) At.,11,(10....,
(lot number)� (grave number)
pName of Sexton or Person in Charge of Premises Bra
W (please print)
Signature Title C M19-'�t3t
(over)
DOH-1555(02/2004)