Metivier, Grace NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Biostatistics -Vital Records Section
iNi Name First Middle Last Sex
Grace Ann Metivier :' female
Date of Death Age If Veteran of U.S.Armed Forces,
---- 2/18/1989 81 ' War or Dates no
Place of Death Hospital, Institution or
City,Town or Village City of Glens Falls Street Address Glens Falls Hospital
C. Cause of DeathAU
:.. . .....
cerihol vascular accident
to Medical Certifier Name Title
C James Morrissey MD
.:;.::.::::...........................................::Address:..........-.......-.............
•
90 South Street, Glens Falls, New York 12801
; Death Certificate ............................................................... . .. ................................................... ..................
Filed , District Number Register Number
City,Town or Village City of Glens Falls
' Date Cemetery or Crematory
QBurial 2/21/1989 Pine View Cemetery
❑Cremation i ress Town of nueens-:ur : N.Y.
..............................:.>::: �,::::.................................................................. ......... ...........................................................................................................
Z Date Place Removed
O 0 Removal and/or Held
..'
I Address
tit:
Cp
iaii Date Point of
N ['Transportation by Shipment
O.
Common Carrier
Destination
..........................................:::::Date::::::..................................................... .... .... ...............................................................................................................
El Disinterment Cemetery Address
ElReinterment Date ': Cemetery Address
€:: Permit Issued to Registration Number
Name of Funeral Firm Regan and Denny Funeral Service, Inc. 02883
:>......Address...........................................::.::::::......::......:..:..::....:::::::::::........:..:..:..:..:.::.........................:::::::::::::::::::::.::::::::::::...................................................... :::::::
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Quaker Road, Queensbury, N.Y. 12804
Name of Funeral Firm Making Disposition or to Whom
iii Remains are Shipped, If Other than Above
:::............:::s....................................................................................................................................................................................................:............::::::,::::::::::...-..... .
10 Address
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........................................................................................................................................................ ............................................................................................... .......... ..........
iigi
Permission is hereby granted to dispose of the hu anJemains descri ed above as indicated.
Date Issued Registrar of Vital Statistics -�-�c 1
signature)
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District Number 610�1 Place .�+�' �, �/,7 •
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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z< Date of Disposition Z'Z-(9 ( Place of Disposition ?I"�p t -'h t+J Oc ---.5 Qti �nts v
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(section) (lot number) (grave number)
Name of Sexton o son in Charge of Premises o 4 1 C'Gr-- y /l v s it.. . L-
•z: please print)-. Signature Title S 0 - ty
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DOH-1555(9/86)p 1 of 2(formerly VS-61)