Guder, Cynthia NEW YORK STATE DEPARTMENT OF HEALTH `�
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Cynthia Stackpole Guder Female
Date of Death Age If Veteran of U.S. Armed Forces,
12/17/1999 8+years War or Dates
Place of Death Hospital, Institution or
City, Town or Village City Of Glens Falls Street Address Glens Falls Hospital
Manner of Death Q'�latural Cause Accident ❑Homicide ❑Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Fred P. Scialabba M. D.
Address
454 Glen Street Glens Falls, Ny 12801
Death Certificate Filed District Number Register Number
City, Town or Village City Of Glens Falls 5601 627
Date Cemetery or Crematory
❑Burial -12/20,11999 Pine View Crematorium
Address
Cremation Queensbury, NY 12804
Date Place Removed
0❑Removal and/or Held
•- and/or Address
Hold
Q Date Point of
NTransportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Flynn Bros. Inc. 00528
Address
90 Main Street Greenwich, N Y
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 descr'bed above intce
Date Issued 12/20/1990 Registrar of Vital Statistics
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition �— '✓ Place of Disposition r �- /� ( Cc i._tea n.;r` U� .,►�_
(address)
to
M (section) (lot number (grave number)
0 Name of Sexton or Person in Charge of Premises
z (please print)
Signature Title _ ' gS�
(over)
DOH-1555 (9/98)