Commanto, Cynthia L ii V
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Cynthia L.Commarto Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/01/2021 57 Years War or Dates
H Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address 43 Ridge Street 502,Glens Falls,New York 12801
p Manner of Death 0 Natural Cause 0 Accident ID Homicide El Suicide ❑Undetermined E Pending
W V Circumstances Investigation
QW Medical Certifier Name Title
Timothy Murphy Coroner
Address
52 Haviland Avenue,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 200
0 Burial Date Cemetery,Crematory or Facility Name
05/06/2021 Pine View Crematory
0 Entombment Address
X❑Cremation Queensbury,New York
El Donation
Removal Date Place Removed
and/or and/or Held
N Hold Address
0
Ct. Date Point of
V) ❑Transportation
p by 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
f. Remains are Shipped,If Other than Above
N Address
CC
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/06/2021 Registrar of Vital Statistics 9y6ert,/7nrlretu Curtis.g ctronicaf 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
W 4or,__
WDate of Disposition h IZi Place of Disposition n
2 (altiress)
W
U)
CC (section) number) (grave number)
elName of Sexton or Person in Charge,f Premises ! �^QL�G�ti���
Ull
/�j (pleasebrint/
Signature /� Title (r✓�'t` -Ple
DOH-1555(o7/18)p 1 of 2
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#
1