Kelleher, Lorraine NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Biostatistics - Vital Records Section
Name First .I , Middle Last # Sex
• Lorraine 15. Kelleher Female
Date of Death A e If Veteran of U.S. Armed Forces,
f April 25, 1993 74 WarorDates None
Place of Death
Z Hospital, Institution or
its City,Town or Village Fort Edward, NY Street Address Fort Hudson Nursing Home
C] -Dealt;Cause of De ..
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Medical Certifier Name Title f .,,.,.:.v....
;4 S. RIchard Spitzer, M.D. -
Address
Box 139 Glens Falls, NY 12801
Death Certificate Filed
District Number Register Number
City,Town or Village Fort Edward, NY1�
Date Cemetery or Crematory
❑Burial April 28, 1993 Pine View Crematory
Address ,... . .
Cremation ury, NY 12804
Quaker Road Queensbury,
Place Removed
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O 0 Removal and/or Held
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rn
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ti Date Point of
(if) ID Transportation by
p Common Carrier Shipment
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❑ Disinterment Cemetery Address
Date ......... ..... :.... .
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❑ Reinterment Cemetery Address
;: Permit Issued to Registration Number
Name of Funeral Firm James F. SIngleton, Inc 01825
• Address �...
... ..,....:.::..::.:.._ ... .:..::::.:.::. 1.4 Bay..Road..9ueensbury, NY 12804 n
}.- Name of Funeral Firm Making Disposition or to Whom
` Remains are Shipped, If Other than Above
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Permission Is hereby granted to dispose of the human mains ')2i4,
bedabove Indicate .
Date Issued Apr 26, 1993 Registrar of Vital Statistics I ' 4 "- C'
:Nii`' District Number 75 Place Town of Fort Edward, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
z: Date of Disposition y 93 Place of Disposition P/t/1(k i�/.f/ yjg,-/Yf f .2-riff/ (/f�
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p Name of Sexton r Person in Charge ,z
of Pr ises J,7/// /1 .977P/51L c
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�. Signature Title e/Fh-- f4T- 'y i 7!/ - ..i
DOH - 1555 (9/86)p 1 of 2(formerly VS-61)