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Sullivan, Joan VLNEW YORK STATE DEPARTMENT OF HEALTH # Z Vital Records Section Burial - Transit Permit %I Name First Middle Last Sex ''f' Joan L. Sullivan Female '; Date of Death Age If Veteran of U.S. Armed Forces, ;r May 30, 2012 62 War or Dates f%%' Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of DeathL2ik Natural Cause ❑Accident ❑Homicide ❑Suicide n Undetermined Pending Circumstances Investigation ' Medical Certifier , Name Title �; �� —ov� bN r art Address s { Cie r1� - �-�,o 6 \ L \ f' Death Certificate Filed 6trict Number Register Numb r City, Town or Village Glens Falls,NY 5601 ❑Burial Date Cemetery or Crematory ❑Entombment June 2,2012 Pine View Crematory Address ©Cremation Quaker Road, Queensbury, NY 12804 Date Place Removed Z Removal and/or Held 2 and/or Address H Hold W 0 Date Point of 85 ❑Transportation Shipment p by Common Destination Carrier ❑Disinterment Date Cemetery Address El Reinterment Date Cemetery Address '. '' Permit Issued to Registration Number Name of Funeral Home Regan& Denny Funeral Home 01444 rf l Address v 94 Saratoga Avenue, South Glens Falls,NY 12803 Name of Funeral Firm Making Disposition or to Whom Ij.r Remains are Shipped, If Other than Above Address Permission is her by ranted to dispose of the human rins des 'bed above s indicated. Date Issued C D J Dj ma , egistrar of Vital Statistics �_ �� (signature) District Number 5601 Place Glens Falls,NY / a '/ I certify that the remains of the decedent identified above were dis osed of in accordance with this permit on: W Date of Disposition L/S II_ Place of Disposition e,,.140.i Ci (-orfc.ti.. 2 (address) W N rg (section) 4 r„�` (l t number) (grave number) pName of Sexton or Pe on in Charge of Premises /omits" 'Z D ( lease print) Signature / Title e (over) DOH-1555(02/2004)