Whiting, Kathryn •
Town of Queensbury
Certification of Cremation
sm Pine View Cemetery and Crematory
This certifies that the remains of: Kathryn Whiting
were cremated on February , 7 20 22 at the Pine View
(Month) (Day)
Crematorium, Queensbury,New York, and these are the cremated remains of said body.
Date of Death Febuary , 4 20 22 Age 85
(Month) (Day)
Funeral Home Regan Denny Stafford Registered No. 108
uthor' ed Sig ture)
r
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
•
Name First Middle Last Six
Kathryn Irene Whiting Female
Date of Death Age If Veteran of U.S.Armed Forces,
02/04/2022 85 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 47 Minnesota Avenue,Queensbury Town,New York 12804
0 Manner of Death ❑X Natural Cause ❑Accident 1=1 Homicide El Suicide ❑Undetermined El Pending
W Circumstances Investigation
W Medical Certifier Name Title
G Emily Rapasadi PA
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 29
Burial Date Cemetery,Crematory or Facility Name
02/07/2022 Pine View Crematory
ElEntombment Address
nCremation Queensbury Town,New York
❑Donation
Z Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
0
O. Date Point of
(I) ❑Transportation Shipment
a by Common
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
Reinterment
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
a Address
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/07/2022 Registrar of Vital Statistics Carolinexktigard Bar1er(Electronicalr Sigrre
(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:
IH- �/,
Z Date of Disposition o2,-. )_�� Place of Disposition p jAc, V't j i Cre, j pjr,r y
(address)
W
N (section) (lot number) (grave number)
0
• Name of Sexton or Perso in Charge of P emises )elMe�' SQl�,fc 3
(please print)
W Signature Title C �`'r`� '�
DOH-1555(07/18)p 1 of 2
0 1 5 6 1 1.
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#
WHITING
NAME Kathryn Whiting Age: 85
Lot Owner: Ruth Rawlins
Lot#Algonquin Sec. D Lot 2 Row1 Grave# 2
Case: Urn
Died: 2.4 .2 2 Interred:5.5.2 2
Funeral Home: Family Ruth Rawlins
Cemetery: Pine View
RAWLINS
Owner
Ruth Rawlins
Address Plot
1906 Sanford Ridge Rd. Oueenshnry NY 12804 A1gnnduin
Phone # Lot #
518-222 .0946 Sec. D row 1 Lot 2
Deed # Date
4313 3 .31 .22
Cost Foundation Y - N
$400.00
Location North. . .Vacant
East. . . .Road
West _ _ _ .Vacant
South. . .Path
Remarks
I ACKNOWLEDGE THE RECEIPT OF THE RULES AND REGULATIONS OF THE
PINE VIEW CEMETERY:
SIGNATURE: �!) 1 C OrD�-' DATE: 2 -51 ` Q
SIGNATURE: DATE:
Record of Interments
Dam
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3 8
4 9
5 10
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