Rowe, Kathleen Angela It Z 110
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Kathleen Angela Rowe Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/01/2021 63 Years War or Dates
F Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
WW Manner of Death EI
Natural Cause Accident EI Homicide 1:1Suicide El Undetermined Pending
U Circumstances Investigation
W Medical Certifier Name Title
CI Sean Bain MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 126
❑Burial Date Cemetery,Crematory or Facility Name
03/03/2021 Pine View Crematory
❑Entombment Address
Cremation Queensbury Town,New York
ElDonation
Removal Date Place Removed
and/or and/or Held
N Hold Address
0
d Date Point of
N ❑Transportation
p by Common Shipment
Carrier Destination
11
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
�_ Remains are Shipped,If Other than Above
.g Address
CC
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/03/2021 Registrar of Vital Statistics p6ertjindirew Cultic(EkctrortcallyStgned)
(signature)
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:
Z Date of Disposition 31 Place of Disposition
2 (address)
W
N (section) (lo umber) (grave number)
Art
Name of Sexton or Person in Charge of Premises/ Z7" S c
Z / (please p t)
lL Signature Title 1 I1V•L
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) ' "' ;' 1A6 0 6
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#