Whitcomb, Kristine Marie -it S--)3
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Kristine Marie Whitcomb Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/03/2022 58 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death Z Natural Cause Accident El HomicideSuicide Undetermined Pending
Circumstances Investigation
EMedical Certifier Name Title
Marcille Labban 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 560
Burial Date Cemetery,Crematory or Facility Name
11/07/2022 Pine View Crematory
Entombment Address
IICremation Queensbury,New York
❑Donation
giRemoval Date Place Removed
-r and/or and/or Held
NHold Address
0
O. Date Point of
M Transportation
C 1 by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
ElReinterment 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
, Remains are Shipped,If Other than Above
Address
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/07/2022 Registrar of Vital Statistics Megan No(in(ECectronica1Ty 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:
eif
Date of Disposition )i 1 g 17/ Place of Disposition tti,U,_
Gam_
aU
2 (address)
Ili
1 (section) (lot number) (grave number)
8 Name of Sexton or Person in Charge of Premises n r' cdiri
/*..._
e print)—`
W Signature Title `
DOH-1555(018)p 1 of 2
:: � o� 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#