Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
DearBorn, Karen A
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Karen A.DearBorn Female Date of Death Age If Veteran of U.S.Armed Forces, 04/13/2023 66 Years War or Dates 1— Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death El Natural Cause Accident 0 Homicide 0Suicide Undetermined ❑Pending W Circumstances Investigation WMedical Certifier Name Title G William Cleaver 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 191 Burial Date Cemetery,Crematory or Facility Name 04/14/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation OZ❑Removal Date Place Removed and/or and/or Held F— Hold Address N 0 O. Date Point of N❑Transportation Q by Common Shipment Carrier Destination O Disinterment 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 F— Remains are Shipped,If Other than Above N Address et W a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/14/2023 Registrar of Vital Statistics Megan5nfn g ctronicaf 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: E— n W Date of Disposition 4-/ 2'gZ3 Place of Disposition V ,' h�@ Liir,P, ) e j 1 f`a( 2 (add W CC CC (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of P mises A I�IJ�i r �� (p ease print) W Signature e J is' Title b eZ- y 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 -ial Funeral Directors Reg.or License#