Trombley, Hattie NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Hattie L. Trombley F
Date of Death Age If Veteran of U.S.Armed Forces,
Apr 10 , 1993 84 War or Dates No
2 Place of Death Hospital, Institution or
'W City,Town or Village Saranac Lake Street Address Adrk Med. C tr .
Manner of heath Natural Cause ❑ Accident Homicide ❑ Suicide UndetermiinedsQ Pending
Circumstance Investigation
#lit Medical Certifier Name Title
4 George S Cook, MD
: Address
Lake Colby Drive , Saranac Lake , NY
Death Certificate Filed District N mber Register Number
City,Town or Village Saranac Lake 1663
Date CemeteryCrematory
or
El Burial Apr . 1 , 1993 Pine View Crematory
Et Cremation Address
Glens Falls, NY
............. .................... ....................................................................................................................................................................................................................................
z Date Place Removed
OI, 0 Removal and/or Held
I and/or Hold .....::................
Address ..: ..
U)
f3L Date Point of
v) 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 M B Clark, Inc . I eG367
Address
27:::.Saranac.:Ave :., Lake Placid, NX__ ....
W. Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
t Address
All
43
Permission is hereby granted to dispose of the human rema n des ibe b ye as indicated.
Date Issued Apr . 13, 199F3agistrar of Vital Statistics t (� V
(s nature _ i1-t
District Number 1663 Place Saranac Lake [Harrietstown] , N. Y .
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition `l�7� Place of Disposition //i"1 44/ e-174-/e/9 �/(U/4
g (address)
w
CC (section) (lot number) (grave number)
p'' Name of Sexton r Person in Charge of Premises
.FOs// PP ,W/977/24/
Z' (please print) �J /-�--
tu Signature .L�' ✓y� -�- Title Gl7.�/f1/49/d/9}/ / 7.S�l l i
DOH-1555 (10/89) p. 1 of 2 VS-61