Hopkins, Edith r •NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
wi Name First Middle Last Sex
Edith M Hopkins Female
Date of Death Age If Veteran of U.S. Armed Forces,
O4/21/2008 85 years War or Dates
t- Place of Death Hospital, Institution or
City, Town coWegcXXXX City Of Glens Falls Street Address Glens Falls Hospital
Iii
Manner of Death Natural Cause ❑Accident 0 Homicide 0 Suicide ElUndetermined ❑Pending
I Circumstances Investigation
;t Medical Certifier Name Title
Bernard R. Villainan M D
Address
88 Broad Street Glens Falls, N Y 12801
Death Certificate Filed District Number Register Number
City, Town OOU� t (XXX City Of Glens Falls 5601 170
i' i ElB'urial Date Cemetery or Crematory
04/24/2006 Pine View Cemetery
❑Entombment Address
[jCremation Queensbury, NY 12804 -
Date Place Removed
Z ❑Removal and/or Held
and/or Address
t= Hold
CO
0 Date Point of
tl
i 0 Transportation Shipment
5 by Common Destination
Carrier
Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan &Denny Funeral Home 01519
ni Address
53 Quaker Road Queensbury, N Y 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
#C
In
ll
` Permission is hereby granted to dispose of the human remains described aboo as ' dicated.
iill Date Issued 04/21/2008 Registrar of Vital Statistics 441- -
(signature)
District Number \5"- 0/ Place ‘9-7,- Al/7/ , y
a.::: I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
k
ILLJI Date of Disposition 4/24/O 3 Place of Disposition P i vllF VIEW CEME f FRY,OUFFNSRURY NY
(address)
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MAD:LL_A 21-8 1
cc (section) (lot number) (grave number)
Ci Name of Sexton or Person i Charge of Premises h I r:HAEL GEN I FIB
(please print)
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Signature C\P4Title SUPT
(over)
DOH-1555 (02/2004)