Gunty, Anne NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Anne M. Gunty female
Date of Death Age If Veteran of U.S. Armed Forces,
12/14/1999 70 War or Dates
Place of Death Hospital, Institution or
City,)TvAKxc rxVWx@a Glens Falls Street Address Glens Falls Hospital
Manner of Death FXJNatural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Frances C. Bollinger, 'MD
Address
10154 Saratoga Rd. , Ft. Edward, NY 12828
Death Certificate Filed District Number Register , umber
City, TX*XiX rk1XaMX4X Glens Falls 5601
Date Cemetery or Crematory
❑Burial 12/16/1999 Pine View Crematory
Address
Cremation Quaker Road, Queensbury,, NY 12804
Date Place Removed
0 Removal and/or Held
•• and/or Address
Hold
Date Point of
N❑Transportation Shipment
fl by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Funeral Home 01594
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 abo as ' c ed.
Date Issued 12/16/1999 Registrar of Vital Statistics
(signature)
District Number 5601 Place City of Glens Falls, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
iF-
W Date of Dispositions ./9:-fl. Place of Disposition Pi/Ve'(f'4dw/ G h e m ctTC6
(address)
iU
>� (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises
g (please print)
Signature Title CC--- 41 k7or
(over)
DOH-1555 (9/98)