Pickett, Catherine Elizabeth •
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NEWYORKSTATEDEPARTMENTOFHEALTH , r \' Burial - Transit Permit '
•
Bureau of Vital Records
•
Name First Middle Last Sex
Catherine Elizabeth Pickett Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/26/2022 74 Years War or Dates
E.. Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death n ❑ ❑Undetermined �Pendin
� x Natural Cause I 'Accident Homicide Suicide g
W Circumstances Investigation
WMedical Certifier Name Title
C Abigail Macomber PA
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 290
RBurial Date Cemetery,Crematory or Facility Name
05/28/2022 Pine View Crematory
Entombment Address
IIICremation Oueensbury,New York
DDonation
(s❑Removal Date Place Removed
and/or and/or Held
I Hold Address
N
0
a. Date Point of
Cl)ETransportation
CI 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
5 Address
CC
W
a.. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/27/2022 Registrar of Vital Statistics Megan Wolin(ECectronicaCtySigned)
(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:
I— _
Z Date of Disposition ,—.2 B ZDI G Place of Disposition P ,Je v.e J e,e-wei �a !�-t�
LU __�
2 (address)
W
U)
CC (section) (lot nu ber) (grave number)
0Rp(Name of Sexton or Person in Char of Pre ise D.� t
Z (p ase print
W Signature Title DfCrx-TaI'
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
9
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Pine View cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#