Loading...
Dennett, Anne NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section .. Burial - Transit Permit -s, Name First Middle Last Sex Anne F. Dennett Female Date of Death Age If Veteran of U.S. Armed Forces, May 21, 2013 46 War or Dates a Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital sit Manner of Death X Natural Cause [i Accident ri Homicide []Suicide n Undetermined Pending Circumstances ' Investigation ut Medical Certifier Name Title c. John Stoutenburg,MD Address Glens Falls,NY \ L86 i Death Certificate Filed District Number Register Number City, Town or Village Glens Falls,NY lag©( 5601 2/ ❑Burial Date Cemetery or Crematory May 22, 2013 Pine View Crematory ❑Entombment Address El Cremation Queensbury,NY Date Place Removed ZZ r-iRemoval and/or Held and/or Address H Hold N 0 Date Point of N El 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 iti Permission is hereby granted to dispose of the human remains describe above as i dica d Date Issued 2 ZO%3 Registrar of Vital Statistics i ed (signature) District Number 5601 Place Glens Falls,NY i ?p I I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 5-7-Z2- t3 Place of Disposition f: ik-Je.— Vi(({ QCA t 44.J III (address) co re (section) alrt,f43iTber) (grave number) g Name of SextonjP,io n Char e of Premises S Z (please priniNs4____ 111 Signature (/ Title ) (over) DOH-1555(02/2004)