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Zimmerman, Carol
15510 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Carol Zimmerman Female Date of Death Age If Veteran of U.S.Armed Forces, 11/03/2021 78 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W Manner of Death Undetermined Pending W © Natural Cause Accident Homicide Suicide Circumstances Investigation Medical Certifier Name Title G 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 489 Burial Date Cemetery,Crematory or Facility Name 11/05/2021 Pine View Crematory Entombment Address lCremation Queensbury Town,New York Donation OZ Removal Date Place Removed and/or and/or Held N Hold Address O 0. Date Point of t/)❑Transportation Q by Common Shipment Carrier Destination El 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 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/05/2021 Registrar of Vital Statistics `R96ertAndrew Curtis(ECectronically 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: Z Date of Disposition /�!'6"2e32'1 Place of Disposition "Pi pi Q �:�c✓ �rC.fi /addr W (section) ''.. / nu ber/ (grave number/ CC SName of Sexton or Person in Charge• remis r ,Qyn�a-�d iti'ar ,AI, (please print) W Signature �!� Title LO�GW� DOH-1555(07/18)p 1 of 2 � 1,53O3 Public Health Law Sec. 4145(2b) Receipt Human remains of t delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#