Catalfamo, Ilene NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section 4 Burial - Transit Permit
Name First Middle Last Sex
Ilene R. Catalfamo female
Date of Death Age If Veteran of U.S. Armed Forces,
04/17/2006 79 War or Dates n/a
144. Place of Death Hospital, Institution or
city,ili
Town orUiliiagec Lake Luzerne Street Address 641 Ralph Road
Eit Manner of Death Natural Cause Accident 0 Homicide Suicide Undetermined Pending
0. Circumstances Investigation
tu Medical Certifier Name Title
44 James North, MD
Address
100 Broad St. , Glens Falls, NY 12801
Death Certificate Filed District Number Register Number /
9', Town c *i Lake Luzerne Lc (P
€ ['Burial Date Cemetery or Crematory
04/19/2006 Pine View Crematory
❑Entombment Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
❑and/o
oldr
Address
t
H
0 Date Point of
NElTransportation Shipment
C by Common Destination
Carrier '
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
' Permit Issued to - Registration Number
Name of Funeral Home Regan & Denny Funeral Home 01519
Address
53 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped, If Other than Above
2 Address
Q
W
Permission is hereby granted to dispose of the hum r mains describe bove as indi ed.
Date Issued $ A-aZaiG Registrar of Vital Statistic �__fic i , r
(signature)
District Number `5a6L, Place Lai& L. Z-Lt_ ,�-e—
,..' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tu Date of Disposition /7,p C.( Place of Disposition� A jt/t1 p j�,,� iv,.l���cc�f--j U�ij'
(address)
U
CC (section) /, (lot number) (grave number)
faName of Sexton or Person in Charge of Premises G i. k/ Cl i 74 I\( �"
2. ( (please print) 77�,
W. Signature �--a-cam Title C l' , F ll�, � �G \
/ (over)
DOH-1555 (02/2004)