Knights, Madalyn t
4 11 3L 1
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
- Madelyn Knights Female
Date of Death Age If Veteran of U.S.Armed Forces,
ft 04/30/2018 97 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death 0 Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
il
Circumstances Investigation
Medical Certifier Name Title
4 Wendy Steinhacker PA
Address
it 100 Park St,Glens Falls,New York 12801
° `, Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 215
❑Burial Date Cemetery or Crematory
05/02/2018 Pine View Crematory
❑Entombment Address
®Cremation Queensbury, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
-, Date Point of
1%1 Q Transportation Shipment
by Common Destination
ry Carrier
❑Disinterment Date Cemetery Address
ft
❑Reinterment Date Cemetery Address
Att
Permit Issued to Registration Number
, Name of Funeral Home Regan&Denny Funeral Service 01444
Address
94 Saratoga Ave,S Glens Falls,New York 12804
? Name of Funeral Firm Making Disposition or to Whom
' Remains are Shipped, If Other than Above
Address
Tr—
' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/02/2018 Registrar of Vital Statistics t)bertA Curtis(E(ectronicaffy Signed)
.` (signature)
'41y; District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
0,4
Lri Date of Disposition S h tit Place of Disposition g,,,1/-../ .,,-4o
'. (address)
T it-
i (section) d(lot num (grave number)
Name of Sexton or Person in Charge of Premises ifwe
E/ (please print)
Signature Title ui6'01114.
(over)
DOH-1555(02/2004)