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Carroll, Isabella Ann # 91'/ NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Isabelle Ann Carroll Female Date of Death Age If Veteran of U.S.Armed Forces, 10/31/2021 87 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation IJJ p Manner of Death © Natural Cause El Accident ❑Homicide El Suicide ❑Undetermined El Pending Circumstances Investigation C.) Medical Certifier Name Title O Courtney Diamond NP Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 474 ❑Burial Date Cemetery,Crematory or Facility Name 11/03/2021 Pine View Crematory ❑Entombment Address EICremation Queensbury Town,New York ❑Donation Z ❑Removal Date Place Removed - and/or and/or Held N Hold Address O a. Date Point of t/) ❑Transportation 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 I- Remains are Shipped,If Other than Above M Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/01/2021 Registrar of Vital Statistics R96ertAnt rew Curtis(ECectronica/Ty 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 IU Date of Disposition (j /y 114 Place of Disposition r•..�. (address) W (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge f Premises G "0)r,— fSmA4 ip- Z (p! se print W Title M rile Signature DOH-1555(07/18)pi of 2 t 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#