Stewart, Alexina NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Alexina Stewart Female
Date of Death Age If Veteran of U.S.Armed Forces,
July 10,2006 94 War or Dates World War II
Place of Death Hospital, Institution or
{�- Town of Queensbury Stanton Nursing&Rehab Centre
Z City, Town or Village Street Address
WW Manner of Death X Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
V Medical Certifier Name Title
W Roslyn Socolof,MD
Address
Queensbury,NY 12804
Death Certificate Filed District Number Register Number
City, Town or Village Queensbury,NY 5657 4//
El Burial Date Cemetery or Crematory
7/13/2006 Pine View Crematorium
❑ Entombment Address
Cremation Queensbury,NY
Date Place Removed
z ❑ Removal and/or Held
p and/or Address
Hold
dN Date Point of
❑ Transportation Shipment
• by Common Destination
G Carrier
Date Cemetery Address
n 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
i,. Remains are Shipped, If Other than Above
Address
OC
Q„ Permission is hereby granted to dispose of the human rema' described above as i sated.
Date Issued 9/ /4� Registrar of Vital Statistics �� f
/ (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:
1- n
Z Date of Disposition J -0;,,a Place of Disposition vat, (co-,
W (address)
2
W
(section) ff , (lot number) (grave number)
O Name of Sexton or Person in Charge of Premises )0,,nt cr
C (please print)
W Signature 411LL-4 Title " r^ c
DOH-1555(02/2004) (over)