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Stoddard, Constance M. a t1.- 1 Igtc NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Constance M.Stoddard Female Date of Death Age If Veteran of U.S.Armed Forces, 02/16/2021 81 Years War or Dates p.. Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital ILI CI Manner of Death ©Natural Cause ❑Accident ❑Homicide El Suicide 111 Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title 0 Marcille Labban MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 103 EiBurial Date Cemetery,Crematory or Facility Name 02/17/2021 Pineview Crematorium ElEntombment Address ElCremation Queensbury Town,New York EiDonation Z Removal Date Place Removed O and/or and/or Held I— Hold Address 0 O. Date Point of N ❑Transportation Shipment p by Common Carrier Destination Date Cemetery Address ❑Disinterment 1=1Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Mason Funeral Home 01117 Address 18 George St Po Box 277,Fort Ann,New York 12827-0277 Name of Funeral Firm Making Disposition or to Whom l— Remains are Shipped,If Other than Above 2 Address LC Ill O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/17/2021 Registrar of Vital Statistics Robert Andrew Curtis(Electronically Signed) (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: I— Z.Z Date of Disposition 714171 Place of Disposition `6LQ--- pJ (address) W CC t number) (grave number) (section) I C 0 Name of Sexton or Person in Charge of Pre .ses ti r.$ �' �Jrnn 411 Z (please int) W ✓' �s Title � i1" Signature DOH-1555(07/18)p 1 of 2 white Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on.burial permit Official Funeral Directors Reg.or License#