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Knapp, Doris NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Doris Knapp female Date of Death Age If Veteran of U.S. Armed Forces, 12 06 1998 72 War or Dates no Place of Death Hospital, Institution or City, It9NJ(4(Xt MMM Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause 0 Accident Homicide Suicide Undetermined Pending Circumstances Investigation XX Medical Certifier Name Title John Babe MD Address 747 Upper Glen Street Queensbury, Y 12804 Death Certificate Filed District Number Register Number <. City, T"")OX"Itwx Glens F6.11s 5601 b 0 Date Cemetery or Crematory ❑Burial 12 08 1998 Pine View Cremator Address 0 Cremation Quaker Road Qu ensbury, NY 12804 Date Place Removed ZRemoval and/or Held .- and/or Address EA Hold Q Date Point of Q Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Sullivan-Minahan & Potter Funeral Home 01837 Address 407 Bay Road, Queensbur , 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 deacribed above sin to . Date Issued ) 2/-7 1 Registrar of Vital Statistics (signature) District Number Placerp I S?� I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: jU Date of Disposition� Place of Disposition / 1 //)/ e (address) LIJ W M (section) (lot nu er (brave number) GName of Sexto or Person in Charge of Premises ,F� Jf� (please print) Signature - Title (over) DOH-1555 (9/98)