Nickerauer, Margaret I
NEW YORK STATE DEPARTMENT OF HEALTH ,,, ///
Vital Records Section Burial - Transit Permit
4
Name First Middle Last Sex
Margaret M. Nickerauer female
Date of Death Age If Veteran of U.S. Armed Forces,
02/12/2006 74 War or Dates n/a
} Place of Death Hospital, Institution or
GIBE Town aiWEircjg Queensbury Street Address Westmount Health Facility
liti
p Manner of Death®Natural Cause 0 Accident El Homicide El Suicide Undetermined Pending
ILICircumstances Investigation
tu Medical Certifier Name Title
S. R. Spitzer, MD
Address
55 Sheridan St. , Glens Falls, NY 12801 _
Death Certificate Filed District Number Register Number
0111, Town wawa Queensbury 5657 /,
❑Burial Date Cemetery or Crematory
02/14/2006 Pine Vlew Crematory
[]Entombment Address
:aCremation Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
Q❑and/or
� Address
Hold
0 Date Point of
N El Transportation Shipment
0 by Common Destination
Carrier '
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address ,
Permit Issued to k 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
N Remains are Shipped, If Other than Above
$ Address
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fl' Permission is hereby granted to dispose of the human re ins described above a indicated.
Date issued ay i c / u C Registrar of Vital Statistics ,,
(signature)
' District Number Place ct C_x �(--�--..
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
ILI Date of Disposition /— )co , Place of Disposition Pi hi E :i;? 6t,ii CAR,i +' 'f- ; (,).!''I
(address)
Ui
ta
CC (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises `iR -R' c k1
Z (please print)
it Signature (* e Title (:).-) .--6i'✓l - r
(over)
DOH-1555 (02/2004)
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