Chadwick, Eileen NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Mi Name First Middle Last Sex
Eileen J. Chadwick female
iiiii]ii Date of Death Age If Veteran of U.S. Armed Forces,
iiiiiii September 27, 1995 69 War or Dates no
Place of Death Hospital, Institution or
City, Town or Village City of Glens Falls Street Address 25 Mason Street
fa
Manner of Death Natural Cause Accident 0 Homicide Suicide Undetermined 0 Pending
f Circumstances Investigation
Medical Certifier Name Title
p Mark Hoffman MD
iiliiiiii Address
102 Park Street, Glens Falls, New York 12801
>: Death Certificate Filed District Number Register Number
City, Town or Village City of Glens Falls ( 6.
Date Cemetery or Crematory
Burial September 29, 1995 Pine View Cemetery
Address
❑Cremation Queensbury, New York
Date Place Removed
22❑Removal and/or Held
and/or Address
Hold
Q Date Point of
N❑Transportation Shipment
0 by Common Destination
Carrier
Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan and Denny Funeral Service, Inc. (115A2
iiiiii
i> Address
53 Quaker Road, Queensbury, New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
Oi
iiiig Permission is hereby granted to dispose of the human remains de cribed above as i icated.
Date Issued Of_ 95— Registrar of Vital Statistics // �' G'
(signature)
` Place �i9//5 Al)"
` ' District Number J�w�� ��'�� G i
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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uj Date of Disposition 9 Place of Disposition P;ii L V i€C a.zM eT e 1Z
2 (address)
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C L))4KI=rZ '\ (9'0ee. NSb0kG-
CC (section) (lot number) (grave number)
GName of Sexton or Person in Charge of Premises U N c).ti tiY - Eke 30 02.
z )gam, lease print)
LU Signature oc. 62�'1 S�f �(i(/ Title (DOR tt itiv 2 ) ?(a .4414
DOH-1555 (10/89) p. 1 of 2 VS-61