Lanna, Esther NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section I. Burial - Transit Permit
Name First Middle s Last Sex
Esther Wallace Lanna Female
Date of Death Age if Veteran of U.S.Armed Forces,
June 23,2006 85 War or Dates
F— Place of Death City of Glens Falls Hospital, Institution or Glens Falls Hospital
Z City,Town or Village Street Address
Wiz Manner of Death X Natural Cause ❑ Accident l El Homicide El Suicide ❑ Undetermined El Pending
Circumstances Investigation
V Medical Certifier Name Title
W William Tedesco,MD
0
Address
Glens Falls,NY
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls,NY _ 5601 2c1 6
CI Burial Date Cemetery or Crematory
6/26/2006 Pine View Cremation
❑ Entombment Address
Q Cremation Queensbury,NY
Date Place Removed
0 Removal
z and/or Held
p and/or Address
F.. Hold
0 Date Point of
O. ❑ Transportation Shipment
by Common Destination
C 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
F,,, Remains are Shipped, If Other than Above
- Address
LU
cL,, Permission is hereby granted to dispose of the human remains descri a ye s i ica
Date Issued 61 Z.61 h-6 Registrar of Vital Statistics ,�
e4----
(signs ure)
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
tZ Date of Disposition L--27 (,L Place of Disposition P, v..t Crt,,4 f G f I „
U (address)
W
Cl)
(section) (lot number) (grave number)
0' Name of Sexton or Person in Charge of Premises (I .c Se.hilt-
0 i) (please print)
W Signature t 11,,r„ j.t.,-m-tzr- Title C rr Iv.f-j-°(
DOH-1555 (02/2004) (over)