Brown, Rebecca 1-15`)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section \ , Burial - Transit Permit
Name First Middle Last Sex
Rebecca Brown Female
Date of Death Age If Veteran of U.S.Armed Forces,
October 1,2006 63 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village City of Glens Falls Street Address Glens Falls Hospital
ILIQ Manner of Death x Natural Cause El Accident ❑ Homicide El Suicide ❑ Undetermined El Pending
Circumstances Investigation
Medical Certifier Name Title
ill Joseph Mihindu MD
Address
20 Murray St.Glens Falls,NY
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 14'7
❑ Burial Date Cemetery or Crematory
10/3/2006 Pine View Crematorium,
❑ Entombment Address
EI Cremation Queensbury,NY
Date Place Removed
z ❑ Removal and/or Held
p and/or Address
H Hold
aN Date Point of
❑ Transportation Shipment
N by Common Destination
G Carrier
Date Cemetery Address
❑ Disinterment
Date Cemetery Address
❑ Renterment
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
t,,,, Remains are Shipped, If Other than Above
2 Address
Ce
QPermission is here v granted to dispose of the human remains descri d bo e a ' dic
,(4,46
Date Issued j0 c)3 O G Registrar of Vital Statistics P .
(signature)
District Number SGo/ Place 5601 ' 7 1.Q /`/ /l"y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
W Date of Disposition t 0 /S/c L Place of Disposition Pin? vi Q C�' *¢fi0(i�,-t
(address)
W
u) (section) ii (lot n mber) (grave number)
0 Name of Sexton or Person in Charge of Premises C h r t s e'7
CI
Z (please print)
W Signature 0Title C rvNV%4,trir
DOH-1555(02/2004) (over)