Purner, Genevieve NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Biostatistics - Vital Records Section
Name First Middle Last Sex
Genevieve Geneva Purner
female
Date of Death
A
9 e If Veteran of U.S.Armed Forces,
F
1/2/88 83 War or Dates no
Place of Death .........
Z Hospital, Institution or
W City Town or Village City Glens Falls Street Address Glens Falls Hospital
Cause of Death
.:..
(3 ::::: : : ::::.::,.:::::::::::::::::::::: ::::.:..::.::::::::.:::::::.::::::. ............................................:...::::......:::::
ii Medical Certifier Name Title
p Richard T. Hogan M.D.
Address
....................::...............
im]
325 Main Street Hudson Falls, NY 12839
Death Certificate Filed................ •
District Number Register Numb
im City,Town or Village City of Glens Falls 5601 s
Date Cemetery or Crematory
)DBurial 1/4/88 i. St. Alphonsus Cemetery
❑Cremation .AddsPown of Queensbury, NY
Z Date Place Removed::.
0, 0 Removal and/or Held
I= and/or Hold .............:..............
Address
N
•
Q.::.. ..:.. ..
G. Date Point of.:.
cn ❑Transportation by Shipment
p Common Carrier
..... ......:..........:..........
...:..:................................:...:..:. .......................................::....:.....: .:.......:.: .
Destination
El Disinterment Date Cemetery Address
❑ Reinterment
Date .... Cemetery Address
....:.:.....:...:....... :........:......................................:................
Permit Issued to Registration Number
Name of Funeral Firm Carleton Funeral Home, Inc. 00356
Address
68 Main St Hudson Falls, NY 12839
.iM Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
t�C Address
ga Permission is hereby granted to dispose of the dead human remains described above as indicated.
iiiik l,L v
Date Issued J/[ g' Registrar of Vital Statistics CGlAa..( g. ISAl tt_.i jhe
/ (signature)
District Number ,5 610 l Place ,..., "a4.4L,di n. / r / b
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W' Date of Disposition 4/9/88 Place of Disposition St. Alphonsus Cemtery, Luzerne Rd., Glens Falls, NY
2 (address)
ut I, Row K 7 2
(section) (lot number) (grave number)
p' Name of Secton or Person in Charge of Premises Rev. Joseph A. Falletta
(please print)
W Signature G, ' Title Pastor
(1:1
DOH - 1555 (9/86)p 1 of 2(formerly VS-61)