Gazdik, Kathryn 1 0 gNEW YORK STATE DEPARTMENT OF HEAL ' �6
Vital Records Section
`� ' Burial - Transit Permit
Name First Middle Last Sex
Kathryn F. Gazdik Female
Date of Death Age If Veteran of U.S. Armed Forces,
07/19/2013 75 years War or Dates
I- Place of Death Hospital, Institution or
ii City, TovIOMIXVi X Glens Falls Street Address Glens Falls Hospital
0 Manner of Death®�latural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined El Pending
Ili Circumstances Investigation
iLi Medical Certifier Name Title
Christopher D. Hoy M. D.
Address
102 Park Street Glens Falls, N Y 12801
Death Certificate Filed • District Number Register Number
City, Tov110(911XV (X Glens Falls 5601 305
1❑Burial Date Cemetery or Crematory
❑Entombment 07/22/2013 Pine View Cemetery
Address
Sili ®Qremation Queensbury, NY 12804
Date Place Removed
C ❑Removal and/or Held
and/or Address
I= Hold
fin
O Date Point of
eL t ❑Transportation Shipment
Q by Common Destination
El Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
fii ElPermit Issued to Registration Number
Name of Funeral Home Regan & Denny Funeral Home 01444
aiiii Address
South Glens Falls, NY
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
,'; Address
IX
la
a` Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/22/2013 Registrar of Vital Statistics LA) .
(signature)
District Number 5601 Glens Glens Falls/ ilk/ (
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2
10 Date of Disposition 1-1,1-3 Place of Disposition 'at Oliu4/ 1 iwctrw _,
(address)
W
c
cc (section) (lot number) - (grave number)
ci Name of Sexton or in Charge of remises r. } JeN44}
2r (pie se print)
Signature Perso Title C �►IVid,
g I
(over)
DOH-1555 (02/2004)