Kanner, Grace 3t3
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Grace Kanner Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/26/2021 97 Years War or Dates Army
Place of Death Hospital,Institution or
• City,Town or Village Queensbury Town Street Address 35 Evergreen Lane Apt 231,Queensbury Town,New York 12804
,p Manner of Death Natural Cause ElAccident ❑Homicide ❑Suicide Undetermined ❑Pending
V Circumstances Investigation
Wl0 Medical Certifier Name Title
Thomas Kandora MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 81
Burial Date Cemetery,Crematory or Facility Name
03/30/2021 Pine View Crematory
❑Entombment Address
X❑Cremation Queensbury,New York
❑Donation
O ElRemoval Date Place Removed
and/or and/or Held
H Hold Address
N
0
1-1
fl❑Transportation Date Point of
CI Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
2 Remains are Shipped,If Other than Above
Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/30/2021 Registrar of Vital Statistics Caroline 7fiCdegarcle Barber(Electronically Signed)
(signature)
District Number 5657 Place Queensbury, 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 3�31 t� Place of Disposition , Zi
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W
2 (address)
W
CC
N
(section) (lot number) (grave number)
8 Name of Sexton or Person in Charge of Pre i es t 14` L nM�Lt
(plea print)
W Signature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) y I ► 14 6 P 1 ,
4
Receipt 1
Human remains of delivered on , 20
i
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# ;