Miner, Katherine NEW YORK STATE DEPARTMENT OF HEALTH Li90
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Katherine S. Miner Female
Date of Death Age If Veteran of U.S.Armed Forces,
November 6,2006 62 War or Dates
Place of Death City of Glens Falls Hospital, Institution or Glens Falls Hospital
Z City, Town or Village Street Address
W Manner of Death X Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
G Circumstances Investigation
V Medical Certifier Name Title
WCI Timothy E.Murphy Coroner
Address
52 Haviland Avenue Glens Falls,NY
Death Certificate Filed District Number Register`JJ
.12_t
City, Town or Village Glens Falls 5601
El Burial Date Cemetery or Crematory
Pine View Crematorium
❑ Entombment Address
0 Cremation Queensbury,NY
Date Place Removed
z ❑ Removal and/or Held
p and/or Address
H Hold
N Date Point of
d ❑ Transportation Shipment
N by Common Destination
G Carrier
Date Cemetery Address
❑ Disinterment
Date Cemetery Address
❑ 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
H Remains are Shipped, If Other than Above
Address
d Permission is hereby granted to dispose of the human remains described 4bove in ' ted
Date Issued /�OS/a 6 Registrar of Vital Statistics /LJ(J
(signature)
District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
1`
Z Date of Disposition II /R job Place of Disposition Inrvll-v rb,Y.ai or w'+•
i
(address)
W
N (section) (lot number) (grave number)
IX
O Name of Sexton or Person in Charge of Premises C- r"f S.e n^MGM"
G (please print)
Z
W Signature Title -iic-C
DOH-1555(02/2004) (over)