Pasco, Chloe NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Chloe Pasco :.:..::.:
Date of Death Age If Veteran of U.S. Armed Forces,
gJanuary 25, 1994 i 103 War or Dates
Place of Death Hospital, Institution or
If,{ City Town or Village . City of Glens Falls Street Address 7.:Va.nderhyd.en:::.Street.
G Manner of Death Undetermined Pending
W ® Natural Cause ❑ Accident ❑ Homicide Suicide
Circumstances Investigation
W Medical Certifier Name Title
p Vitale H. Pagenelli MD
:.::...................................................................................................................................................................................................................................................................:::........:....
Address
65 Elm Street, Glens Falls, N.Y. 12801
..................................................................................................................................................................................................................................................................................
Death Certificate Filed District Number Register Number
City,Town or Village City of Glens Falls 10
Date Cemetery or Crematory
®Burial January 27, 1994 Pine View Cemetery
❑Cremation
Address
Queensbury, New York
z Date Place Removed
0 ❑ Removal and/or Held
i— and/or Hold .::..:.
Address
N
ti Date Point of
cn' 0 Transportation by Shipment
p' Common Carrier
Destination
. . ............................................................................................................................................................................................................................................................................
Disinterment Date Cemetery Address
El Reinterment Date Cemete Address
Permit Issued to ` Registration Number
Name of Funeral Firm Regan_ and Denny Funeral_Home., 01583:..
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
Address
Permission is hereby granted to dispose of the hums main/ u-� ris described above� as indicated.
Date Issued /� 1/ �>�`�q Registrar of Vital Statistics 4 /�-
G��- ei12i3. )6-0
C (signature)
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District Number f Place c..-:l,t J,„Z-49Q,, / - `;--it)/
I certify that the remains of the decedent identified above were disposed of in accordarVce with this permit on:
I=-
Z Date of Disposition 1/27/94 Place of Disposition Pine View Corp_+-ery QuPensbiiry NY-1780-4
Lu
2 (address)
LU Unidilla 98 8
cnCC' (section) (lot number) (grave number)
Op Name of Sexton erson in Charge of Premises Rodney G. Mosher
Z (please print)
W Signature ;�2 ;t�.ez,; .---ki \�'Y� v u...____ Title Supt .
DOH-1555 (10/89) p. 1 of 2 VS-61