Hill, Gladys NEW YORK STATE DEPARTMENT OF HEALTH
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Vital Records Section . {`t Burial - Transit Permit
Name First Middle Last Sex
Marlys Hill F
iiiM Date of Death Age If Veteran of U.S. Armed Forces,
07/09/2006 87 War or Dates
14 Place of Death Hospital, Institution or
< City, Town or Village Glens Falls Street Address 307 R;d St
c1 Manner of Death El Natural Cause ❑Accident ❑Homicide ❑Suicide Undetermined ❑Pending
Circumstances Investigation
U.
Medical Certifier Name .. Title
0.
Address
pi Death Certificate Filed District Number Register Number
>" City, Town or Village Glens Falls —5 60 1 , c6nj 2 29
El Burial Date Cemetery or Crematory
07/11/06 Pine View Crematorium
i > El Entombment Address
Cremation Quaker Road Queensbury, NY 12801
Date Place Removed
Removal and/or Held
and/or Address
h Hold
0 Date Point of
�"0 Transportation Shipment
L by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan and Denny Funeral Service 01 519
Address
53 Quaker Road, Queensburv, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Ir
Permission is hereby granted to dispose of the hu n remai s desceed above - •icated.
gi Date Issued +7 // Q / 0-6Registrar of Vital Statistics Zi(- -P----17 7;7
L
(signature)tJ �•
District Number 5-6 O 1 Place 6 l>zmS F f l S GV 7
iiiii I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
7
Date of Disposition 7 -' -C,L Place of Disposition Az v,c,- C c.-tC^, v
(address)
U1
6 (section) (lot number) (grave number)
0 or, c.,,,..„,,,-
t Name of Sexton or Person in C arge of Premises
Z a (please print)
Signature ', Title r"-
(over)
DOH-1555 (02/2004)