Dufour, Josephine NEW YORK STATE DEPARTMENT OF HEALTH BUCIaI _ Transit Permit
Bureau of Biostatistics - Vital Records Section
Name First Middle Last : Sex
Josephine M. Dufour Female
Date of Death : Age If Veteran of U.S.Armed Forces,
Jan 16• 198 7 8 5 War or Dates No
Z Place of Death Hospital, Institution or
City,Town or Village City of Glens Falls : Street Address Glens Falls Hospital
.Ea Cause of Death
Cerebral Vascular Accident
:411 Medical Certifier Name Title
P. _William...St..:::.John, _MD.: .
Address
mi464:.:G.l.eii St....:...:Gl.ens:.::Fals.-.... :.Y:. 1..2.80]..:..:... ..:..
Death Certificate Filed District Number Register Number
City,Town or Village City of Glens Falls 5601 07
Date Cemetery or Crematory
XE3Burial Jan. 19, 1987 St. Alphonsus Cemetery
❑Cremation Address
Twn Queensbury, N.Y.
z Date Place Removed
O ❑ Removal i and/or Held
—. and/or Hold ...........:
)
Q'... ..... ._ .. ::............... bate Date Point of:.
N', ❑Transportation by Shipment
p Common Carrier ...... ...:... .:..... .:.: :.. :.... ... .. ..,:.. ...:..
Destination
❑ Disinterment
Date ,..Cemete Address
❑ Reinterment
Date Cemetery Address..... ::
Permit Issued to Registration Number
...:.Name of Funeral Firm.::.Carleton Funeral Home., :Inc. ..... .....:. .:..:.:.: ....::: ...:. :.00356
Address
...........6 .....M4.in.. t:.::,: Hudson.: Falls,_..:N.,Y ::. 12 .39.
8 ............. :::. .....
Name of Funeral Firm Making D..Sisposition or to Whom
Remains are Shipped, If Other than Above
31.E Address
is
Permission Is hereby granted to dispose of the dead /ay1 re ins des bed above asIndicated.
Date Issued /-:74 7 Registrar of Vital Statistics ,.i?-/2
,-.4>/
gnature)
District Number 6-6d Place 1 ,L./, / fig`
I certify that the remains of the decedent identified above were dispose in accordance with this permit on:
F-
Z Date of Disposition 4_23-87 Place of Disposition Luzerne Rd. & Pine, Queensbury, NY
w.
2 II (address) 25
iu 1
Ct. (section) (lot number) (grave number)
p. Name of Secton or Person in Charge of Premises Rev. ._ William M. Bauer
w' ) J :, } (please print)
Signature Lj. ( . ,, .,.,J1 •, ,.� Title Pastor
DOH-1555 (9/86)p 1 of 2(formerly VS-61)