Bombe, Adolph NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Biostatistics -Vital Records Section
!-M Name First Middle Last iE Sex
Adolph Bombe Male
Date of Death Age If Veteran of U S Armed Forces
11/4/87 90 War or Dates Yes
--- Place of Death
= Hospital, Institution or
.1..0 City,Town or Village City of Glens Falls Street Address
Glens Falls Hospital
f:14 Caus of Der;?`
la M I rtifier ame Title
1:) Stevens ID
Address
17 Pine St. , Glens Falls, N. Y. 12801
Death Certificate Filed ;:. District Number Register Number
City,Town or Village City of Glens Falls
Date Cemetery or Crematory
ID Burial 1/6/S87 Pine -- Crematorium,
Queensbury, N. Y.Y
E Cremation Address . .
Z i: Date Place Removed
0 0 Removal and/or Held
—
1-- and/or Hold i, -
ress
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Ca. .. . ... . . .. .... .... ... ... . .
Date ................. ... ..... .. .. .. .... .... .
Point of
(,) 0 Transportation by
Shipment
Common Carrier
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Destination
Date Cemetery Address
El Disinterment
Date Cemetery Address
I-1 Reinterment
1--1
Permit Issued to Registration Number
a Name of Funeral Firm Regan and Denny , Inc. 02883
Address
Quaker Road, Glens Falls, N. Y. 12801
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
lik
Permission Is hereby granted to dispose of tf.le. dead hu n mai pd ,4ibed bove as in(„dicate)d.
Date Issued //_.,5—.6e4-7 Registrar of Vital Statistics
. . District Number ....6-6,o/ Placeg;,.....„z.03'a e,4: ... _......, /;2a.ce,-,
I certify that the remains of the decedent identified above were dispose in accordance with this permit on:
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Z Date of Disposition to il Place of Disposition . ri„L, C.A.-rn1—cL1.tj,2,-,,,, -1(, /1 , 4L-A--,41.14-1
2 (address)
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CC (section) (lot number) (grave number)
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p Name of Secton or Person in Char e of Premises 4 Ai A., 0 Z c
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Signature (please print)
e) . Title _.1),
DOH - 1555 (9/86)p 1 of 2(formerly VS-61)