Brown, LaRue NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
>s Name First Middle Last Sex
LaRue Truman Brown female
Date of Death Age ' If Veteran of U.S. Armed Forces,
March 13, 1994 66 War or Dates no
H Place of Death Hospital, Institution or
City, Town or Village City of Glens Falls Street Address Glens Falls Hospital
13 Manner of Death E' Natural Cause Accident E Homicide E Suicide ri Undetermined El Pending
Circumstances Investigation
iirti Medical Certifier Name Title
P Andrew Garner MD
Address
100 Broad Street, Glens Falls, New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village City of Glens Falls 1 44
Date Cemetery or Crematory
0 Burial March 17, 1994 Pine View Cemetery
Address
❑Cremation y _ Queensbury, New York
Date Place Removed
Z❑Removal and/or Held
r- and/or Address
1- Hold
0
Q Date Point of
ItQ Transportation Shipment
a by Common Destination
Carrier
Disinterment Date ' Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
ia
MI Name of Funeral Home Regan and Denny Funeral Service, Inc. (l1 5112
Address
26 Quaker Road, Queensbury, New York 12804
iiM
'' Name of Funeral Firm Making Disposition or to Whom
`g Remains are Shipped, If Other than Above
: Address
UI
ini Permission is hereby granted to dispose of the huma emain cribed ove as indicated.
Date Issued 3--/S-9/ Registrar of Vital Statistics, ,/z.r X L��®'�' id
(signature) C.-,,
District Number ,57jp/ Place
iim
I certify that the remains of the decedent identified above were disp d of in accordance with this permit on:
1F.-
Z. Date of Disposition 3/17/94 Place of Disposition Pine View Cemetery
w (address)
to Mohican 64 C 2
IX (section) (lot number) (grave number)
AName of Sexton or Person in Charge of Premises Michael Lopez
g (please print)
it! Signature ? 7"- Title Work Foreman
DOH-1555 (10/89) p. 1 of 2 VS-61