Webster, Gladys NEW YORK STATE DEPARTMENT OF HEALTH •
Burial - Transit Permit
Bureau of Biostatistics -Vital Records Section
Mi Name First Middle Last Sex
Gladys M. Webster > female
<.:::Date of Death::::. ...........................................::.::.a::.e::::::..............::.::: ::::. .::::::n.:::::.
Vetera of U.S.Armed Forces,.....
9 ............. .....::... '
....4/12./8.9 ...._._ 78 War or Dates
Place of Death Hospital, institution or
104...City,Town or Village Ar. ...1.e..................................................... Street Address Plea nt.... .
?t Cause of Death
44
...Re.s... r.atory...F.a .,l..ure...................................................................................................................................................................
Ati Medical Certifier Name Title
GM.......J......L...n.Gh............................................................... ID......................... ..............................................................................
Address
1.9..... .ua.ke.r....S.t.............. .....Granville...........NY...............
mi Death Certificate Filed District Number Register Number
iiiiiM City, ow •rVillage Argyle • 5750 8
Date Cemetery or Crematory
®Burial 4/14/89 Seeley Cemetery
❑Cremation Address
Queensbury NY
..:.....:::....:.:...::.....:.::.............:..:.............:.:.::..................:......::........:.::::::::.::.:..::::.:..:::::::.....:.....::::..
.,z: Date Place Removed
+_O 0 Removal and/or Held
and/or Hold
f. Address
[ti Date Point of
N': ['Transportation by Shipment
Common rrier
Destination
❑ Disinterment ' Date Cemetery Address
El Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Firm Regan & Denny Funeral Service 02883
Address
26....Quaker....Rd. Queensbury ...NY....... .. ....................... ..................
iigi Name of Funeral Firm Making Disposition or to Whom
j Remains are Shipped, If Other than Above
.............................................................................................................
ltr.
Address
Atit
0............ ...
Permission is hereby granted to dispose of the human emains described above as indicated.
ift Date Issued 4/13/8 9 Registrar of Vital Statistics ,- -7-cz..cJ
(signature)
': District Number 5750 Place Town of Argyle
igiii
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition I Place of Disposition 1 ii d e- /�o u d U,e.,e•ir&'')`
(address)
w Ue'l Ad cc,l/ UI?/Sb /-/i 6/4/fa w.7
t (section) (lot number) (grave number)
O`
i'p Name of Sexton or Person in Charge of Premises 6 r i 4 4 /r e e_
Z t (please print)
w Signature s" (/ Title O P e fl 61 Ac% .-----
DOH-1555(9/86)p 1 of 2(formerly VS-61)