Chilson, Nina 3 ?q
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Nina Wulson Chilson Female
Date of Death Age If Veteran of U.S.Armed Forces,
August 31,2006 89 War or Dates
Place of Death Town of Queensbury Hospital, Institution or 27 Woodvale Road
Z City,Town or Village Street Address
ILI Manner of Death X Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
V Medical Certifier Name Title
141
William Borgos,MD
Address
Queensbury,NY
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury,NY 5657 g O
❑ Burial Date Cemetery or Crematory
9/1/2006 Fine View Cremation
❑ Entombment Address
El Cremation Queensbury,NY
Date Place Removed
O 0 Removal and/or Held
and/or Address
E Hold
N Date Point of
ate,. ❑ Transportation Shipment
4,..) by Common Destination
Carrier
Date Cemetery Address
❑ Disinterment
Date Cemetery Address
0 Reinterment
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
Remains are Shipped, If Other than Above
Address
re
dPermission is hereby granted to dispose of the human re i s described a ve ii icated.
Date Issued f/ l r� o Registrar of Vital Statistics �•Ct,�_-� (, (Jj3
(signature)
District Number 5657 Place Queensbury,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
�Z Date of Disposition 9 Alt:L Place of Disposition Pin t v,.e 6r t,,,c.u c, ,,,*
(address)
W
N (section
Ce
)) (lot number) (grave number)
GName of Sexton or Person in Charge of Premises CI e.t CP.,rrec(
Z (please print)
W Signature Title Cre>IN o,'i or
DOH-1555 (02/2004) (over)