Yeo, Ernestine NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Biostatistics -Vital Records Section
Name First Middle Last Sex
Ernestine A. Yeo Female
Date of Death Age If Veteran of U.S.Armed Forces,
1-12-87 76 yrs ! War or Dates No
Place of Death Hospital, Institution or
Falls Street Address Eden Park Nursing Home
t:1 Cause of Death
a Respiratory Arrest
j Medical Certifier Name Title
p Robert L. Evans M.D.
Nii Address
Pine Cor Elm, Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City,Town or Village City of G1 ens Falls -,
Date Cemetery or Crematory
❑Burial 1-13-87 Pine Crematory
3 Cremation : Address
Town of Queensbury, NY
•Z• Date Place Removed
Oj, ❑ Removal and/or Held
and/or Hold .:.Address
..................... .....: :
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p„' Date Point of
0 0 Transportation by Shipment
p Common Carrier .........:. :........:... ..........:_..........
Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Firm Regan & Denny, Inc. , Quaker Rd. , Glens Falls, NY 02883
Address
44 Name of Funeral Firm Making Disposition or to Whom
ii2': Remains are Shipped, If Other than Above
Address
10 _
Permission is hereby granted to dispose of the dead human remains descri ed above as indicated.
: Date Issued l (��l g 7 Registrar of Vital Statistics ( �� 9
PR 1 (signature)
District Number, Place G
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
E-
Z Date of Disposition / /3/�7 Place of Disposition P, /€ C . /'e' frii ' ?Lc.r i v%'ti ` ./a'`"ti Cl-
W` (address)
W
tY.
(section) (lot number) (grave number)
p' Name of Secton or Person in Charge of Premises --/41 ti A_ V2d5 5 -s/t•
Z .
` (please print)
w, Signature a-tl Title c'// v
DOH -1555 (9/86)p 1 of 2(formerly VS-61)