Burritt, Kathleen NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
KATHLEEN S. BURRITT
Date of Death Age If Veteran of U.S. Armed Forces,
11 10 91 84 YRS. War or Dates NO
Place of Death Hospital, Institution or
[il City,Town or Village CITY OF GLENS FALLS Street Address GLENS FALLS HOSPITAL
W Manner of Death ® Natural Cause El Accident ❑ Homicide El Suicide ❑ Undetermined El Pending
Circumstances Investigation
(a Medical Certifier Name Title
ln DANIEL WAY, M.D. MEDICAL PHYSICIAN
Address
m NORTH CREEK HEALTH CENTER, NORTH CREEK, NY 12853
Death Certificate Filed District Number Register Number
City,Town or Village CITY OF GLENS FALLS _3--.0
Date Cemetery or Crematory
❑Burial 11-12-91 PINE VIEW CREMATORIUM
ElCremation
Address
QUEENSBURY, NY 12804
Z Date Place Removed
OI', Q Removal and/or Held
i and/or Hold ....:
Address
Cl)
ci. Date Point of
0'' ❑Transportation by Shipment
p Common Carrier ....................................:.:.. .
Destination
❑ Disinterment Date Cemetery Address
.: :
❑ Reinterment Date CemeteryAddress
Permit Issued to Registration Number
Name of Funeral FirMEGAN & DENNY FUNERAL SERVICE, INC. 01632
Address
26 QUAKER ROAD, QUEENSBURY, NY 12804
Name of Funeral Firm Making Disposition or to Whom
g Remains are Shipped, If Other than Above
:US
Address
a
Permission is hereby granted to dispose of the hum remains des ' b,f as indicated.
Date Issued /�l� �/ Registrar of Vital Statistics ,�40
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District Number J�/ Place QaZ� G���" �s p 7
I certify that the remains of the decedent identified above were disposed of in acco nce with this permit on:
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Z Date of Disposition///c.��/ Place of Disposition /./.6-L4�4J �/r.�i ,9)5' i/41
La
2 (address)
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NCC` (section) (lot number) (grave number)
g Z74 , /C. ,/z77f , 4C,J
p' Name of Sexton o Person in C ar a of Premises
Z`; (please print) � �
W Signature - i asp-- Title �y � f 7'
DOH-1555 (10/89) p. 1 of 2 VS-61