Romano, Jean NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Jean Rose Romano female
Date of Death Age If Veteran of U.S. Armed Forces,
November 20, 1993 53 War or Dates no
Place of Death Hospital, Institution or
It,/ City,Town or Village Town of Lake George Street Address Interstate 87 Exit 21
1.2
Manner of Death 0 Natural Cause 0 Accident Homicide Suicide Undetermined 0 Pending
Circumstances Investigation
44.1 Medical Certifier Name Title
ri Paul Bachmann MD
Address
=` Warrensburg, New York
Death Certificate Filed District Number Register Number
City,Town or Village Town of Lake George 5 S/ .
Date Cemetery or Crematory
❑Burial
November 24.,.. 1993 Pine View Crematory......:.:.........::..........:....
Address
L Cremation Queensbury, New York 12804
Z Date Place Removed
O 0 Removal and/or Held
F-; and/or Hold ress
:::.:........... :.
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Add .. ..:.:.:. .
........:..:.:........_ ........ :..:. _...:...:. ..::: ....: _ .... ...
ri. Date Point of
0 Transportation by
p Common Carrier Shipment
Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
<> Permit Issued to Registration Number
Name of Funeral Firm Regan and Denny Funeral Service, Inc 01583
Igi Address
26 Quaker Road, Queensbury, New York 12804
Name of Funeral Firm Making Disposition or to Whom
;g Remains are Shipped, If Other than Above
311
::::Address
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Permission is hereby granted to dispose of the human r mains described above as indicated.
`' Date Issued // - ' Registrar of Vital Statistics : —tom .' r y -) L4-7`1-'
(signature)
District Number _ � =' Place _7�`'` � ,�� Gc
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
!Z Date of Disposition// — - /7 ,i Place of Disposition "dE—/A-4i , 41,9 24'/'I4 I
M'; (address)
w
N
(section) (lot number) (grave number)
° Charge ,�p'' Name of Sexton •r Person in of Pre ises �1����
Z + (please print)
Signature Title e" /l i// _
DOH-1555 (10/89) p. 1 of 2 VS-61