Manell, Louise NEW YORK STATE DEPARTMENT OF HEALTH LI O
s
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Louise E. Manell female
Date of Death Age If Veteran of U.S. Armed Forces,
09/09/2006 74 War or Dates n/a
14 Place of Death Hospital, Institution or
Z City, Zl��(r]IRV51� Glens Fallls Street Address Glens Falls Hospital
a Manner of Death®Natural Cause Accident Homicide Suicide Undetermined �Pending
Circumstances Investigation
a Medical Certifier Name _ Title
Sean Bain, MD
Address
100 Park St. , Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
>>» City,11612i> I aX Glens Falls 5601 q 115
114 0Burial Date Cemetery or Crematory
09/12/2006 Pine View Crematory
gi ❑Entombment Address
iiii0Cremation Queensbury, NY
i " Date Place Removed
a❑Removal and/or Held
and/or Address
M.0
Hold
0 Date Point of
Transportation Shipment
C! by Common Destination
Carrier
Date Cemetery Address
<; Q Disinterment
a Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Funeal Home 01919
Address
53 Quakrr Road,Qteensbury, NY 1280/i
Name of Funeral Firm Making Disposition or to Whom
1-4 Remains are Shipped, If Other than Above
Address
f
ti
CL
` Permission is hereby granted to dispose of the human remains describe above as indi ed.
Date Issued f s Registrar of Vital Statistics 4ta Gtc
+ g (signature)
District Number (3) Place 6 �s Vo,1151 ��
``':;.; I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Cecmcf crivy..,
1� Date of Disposition C�/13/6b Place of Disposition -P�n r v,t w
(address)
111
CO
CC (section) (lot number) (grave number)
0
)c Name of Sexton or Person in Charge of Premises CIAr% . ce4ieikf
N� (please print)
Signature Title Cram At 0 r
(over)
DOH-1555 (02/2004)