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Snowball, Cynthia « i NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Female Cynthia Snowball Date of Death Age If Veteran of U.S. Armed Forces, 3/19/2012 74 i War or Dates no }„ Place of Death I Hospital, Institution or X CiVOU0SOCIMINT4 Glens Falls Street Address Glens Falls Hospital Manner of Death(�Natural Cause 0 Accident El Homicide El Suicide EIUndetermined ❑Pending Circumstances Investigation Medical Certifier Name Title ')p Karissa Scarabino DO Address ;:1 135 North Rd., Wilton,NY 12831 Death Certificate Filed 1District Number Register Number , CitYXXXXXXDOX Glens Falls 1 5601 /35 Date ' Cemetery or Crematory ❑Burial 1 3/23/2012 Pine View Crematory Address _ - ©Cremation i Queensbury,NY Date Place Removed a❑Removal and/or Held �» and/or Address a Hold 0 ? Date Point of eE Transportation Shipment 0 by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address '' Permit Issued to Registration Number = Name of Funeral Home Brewer Funeral Home, Inc. 00211 Address 24 Church St., Lake Luzerne,NY 12846 Name of Funeral Firm Making Disposition or to Whom ii" Remains are Shipped. If Other than Above Address W Permission is hereby granted to dispose of the human remains describ abo e ink•/•' :d. Date Issued a3/2/A0/2— Registrar of Vital Statistics � ,:2 i' l�, (signature) // District Number 54,4/ Place �`l-s, fry I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: tr- uii! Date of Disposition ' -Z -I t Place of Disposition ?nt Uu,-) Crr..ci Of Roos (address) ill CA CC (section) (lot number) e (grave number) GName of Sexton or Per on in Charge=f Premises Ajr=yi�t t CAfilf (please print) 1 44 Signature 's �,,._ Title coEuilq.t( DOH-1555 (10/89) p. 1 of 2 VS-61