Constable, Colleen B / 1
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NEW YORK STATE DEPARTMENT OF HEALTH • Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Colleen B Constable Female
Date of Death Age If Veteran of US.Armed Forces,
11/02/2022 95 Years War or Dates
F. Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death a Natural Cause ❑Accident Homicide Duicide FlUndetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
0 Bo Li MD
Address
100 100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 557
Burial Date Cemetery,Crematory or Facility Name
11/04/2022 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held
H Hold Address
N
O
Q. Date Point of
U)❑Transportation Shipment
Q by Common
Carrier Destination
DisintermentDate Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
Address
7 Sherman Ave,Corinth,New York 12822
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped,If Other than Above
a Address
W
0' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/04/2022 Registrar of Vital Statistics Megan Nolin(Electronically Signed)
(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 J/all U. Place of Disposition
(address)
W
Q (section) / (lot number) sitvl (grave number)
1Name of Sexton or Person in Charge of P ses
Z ease print)
W Signature Title 1MONT°
DOH-1555(07/18)p t of 2
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# '