Galvin, Anne . 1 i 55,E
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
o Name First Middle Last Sex
Anne G. Galvin Female
Date of Death Age If Veteran of U.S. Armed Forces,
10/20/2018 79 War or Dates
4, Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address 43 Beekman Place
Manner of Death C Natural Cause Accident ❑Homicide n Suicide Undetermined n Pending
Circumstances Investigation
Medical Certifier Name Title
T Coppens,MD
Address
3 Irongate,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
di City, Town or Village Queensbury 5 I0 5 i 14-1
0 Burial Date Cemetery or Crematory
Entombment October 22, 2018 Pine View Crematory
Address
®Cremation Quaker Road,Queensbury,NY 12804
Date Place Removed
ZZ U Removal and/or Held
and/or Address
H Hold
N
0 Date Point of
Nn Transportation Shipment
a 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
4 Address
,' 53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10--a3- a0($ Registrar of Vital Statistics '—ter
,/�'t- ,t,c.0 tm......
(signature)
District Number 51e51 Place Queensbury
H I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W .P4 Date of Disposition /0hti lig Place of Disposition kit.. i ur_
W (address)
N
re
(section) (lot n ber) (grave number)
pName of Sexton or Person in Charge of Premises ni Sa..oat
Z (please print
WN J
Signature * Title Ai TOIL-
(over)
DOH-1555(02/2004)