Fee, Doreen Rose NEW YORK STATE DEPARTMENT OF HEALTH 0$110 '' •
Burial - Transit Permit
Bureau of Vital Records
Name First Middle •r ._.,o, Last Sex
Doreen Rose Fee Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/24/2022 66 Years War or Dates
i_ Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address Glens Falls Hospital
Q Manner of Death 1=1NaturalCause Accident Homicide Suicide Undetermined ❑Pending
W
V Circumstances Investigation
0ILI Medical Certifier Name Title
Asim Chaudry MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 228
Burial Date Cemetery,Crematory or Facility Name
v 04/27/2022 Pine View Crematory
Entombment Address
MCremation Queensbury,New York
,1=1Donation
oz❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
0. Date Point of
V) Transportation
a by Common Shipment
Carrier Destination
ODisinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
2 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/26/2022 Registrar of Vital Statistics `Megan Wolin(ECectronica1TySigned)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H ,/_
WDate of Disposition �Z$ in. Place of Disposition '�r '/'" �",«
M (address
W
CC N (section) (lot number) (grave number)
g Name of Sexton or Person in Charge of Premiss A
IN S.1 t,,(
Z /,�� /P/e print) *AWL
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W Signature 6�' Title 4 F v�" 1 G�
DOH-1555(07/18)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#