Torchetti, Rosemary NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section 3 Burial - Transit Permit
Name First Middle Last 1 Sex
Rosemary Torchetti Female
Date of Death Age If Veteran of U.S. Armed Forces,
March 10, 2012 78 War or Dates
N Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address The Pines Of Glens Falls
aManner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
dCircumstances Investigation
u.s Medical Certifier Name Title
0 Suzanne Rayeski,MD
Address
Glens Falls,NY 12801
Death Certificate Filed District Number ' Register Number
City, Town or Village Glens Falls,NY 5601 il
III Burial Date Cemetery or Crematory
March 14, 2012 Pine View Crematory
❑Entombment Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
ZO I I Removal and/or Held
and/or Address
H Hold
O Date I Point of
NTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton-Healy Funeral Home 01596
Address
407 Bay Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Ir- Remains are Shipped, If Other than Above
2 Address
C
di
O. Permission is her by granted to dispose of the human r ains de ibed abo as indicat=d.
Date Issued /)` )7jJ� Registrar of Vital Statistics ( �,.../—t
(signature)
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were isposed of in accordance with this permit on:
W Date of Disposition 3l oil t Place of Disposition cwtt .) <rrr 'o4•0,.—
W (address)
U) --
CL (section) J (lot number) < (grave number)
QName of Sexton or Person in Charge f Premises Il r,at to 4 r ,N 94
4 I (please print)
LU
Signature Title Catli Ott-
(over)
DOH-1555(02/2004)