Leigh, Alma '316
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Alma Beatrice Leigh Male
Date of Death Age If Veteran of U.S.Armed Forces,
September 1,2006 91 War or Dates
Place of Death Town of Queensbury Hospital, Institution or Westmount Health Facility
Z City,Town or Village Street Address
W Manner of Death X Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
V Medical Certifier Name Title
W
Address
Death Certificate Filed District Number Retgr Number
City,Town or Village Queensbury,NY 5657 L�,
El Burial Date Cemetery or Crematory
9/1/2006 Pine View Crematory
❑ Entombment Address
Cremation Queensbury,NY
Date Place Removed
z ElRemoval and/or Held
• and/or Address
Hold
O Date Point of
0.. ❑ 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
Remains are Shipped, If Other than Above
- Address
aPermission is here y granted to dispose of the human described above s i icated.
Date Issued q 1 1 /C Registrar of Vital Statistics �--Z (�
(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:
i...
WDate of Disposition 9 J 1,/a t, Place of Disposition 19i aPv ke v Cfe m 4t°r ;VON
(address)
W
(section) (lot number) (grave number)
O Name of Sexton or Person in Charge of Premises C 1 r , S e,,n e/t
WCt y (please print) /�
Signature 6'.44., -��t,,",n�,ef-' Title (. re.,,ef-��
DOH-1555 (02/2004) (over)