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LaRich, Ella NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last S Ella Helen LaRich female `' Date of Death Age If Veteran of U.S. Armed Forces, IR November 22, 1996 86 War or Dates no Place of Death Hospital, Institution or Glens Falls Hospital City, Town or Village City of Glens Falls Street Address P 1Manner of Death®Natural Cause Li Accident 0 Homicide 0 Suicide r 7Undetermined ri Pending Circumstances Investigation itj Medical Certifier Name Title Vitale H. Paganelli MD M. Address 65 Elm Street, Glens Falls, New York 12801 :iii::ii Death Certificate Filed District Number Register Number ! City, Town or Village City of Glens Falls 60/ 5-e-ic Date Cemetery or Cremator ©Burial November 25, 1996 PIne View Cemetery Address ❑Cremation Queensbury, New York gDate Place Removed V ❑Removal and/or Held ••- and/or Address gHold Q Date Point of N Q Transportation Shipment 3 by Common Destination Carrier : Disinterment Date Cemetery Address Reinterment Date Cemetery Address iliA Permit Issued to RegistratiauJ.Jumber `<l Name of Funeral Home Regan and Denny Funeral Service, Inc. Address 53 Quaker Road, Queensbury, New York 12804 `M Name of Funeral Firm Making Disposition or to Whom . Remains are Shipped, If Other than Above Address >i Permission is hereby granted to dispose of the human remains described above inc'meted. >° Date Issued // 25 4. Registrar of Vital Statistics /4,�� �e G'� / /9' 9 (signature)_ / Ni. District Number 54O/ Place Le-is,. MA .".-2/ I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: .I faDate of Disposition 11/2 5/96Place of Disposition Pine V-I_ew Cemetery ,Queensbury ,NY .+2 (address) W 11nadi 1 1n 336 6 CC (section) (lot number) (grave number) GName of Se or Person in Charge of Premises Rndne\r G.G . Mosher. z � (please print) Signatur ��Q�o;..‘ ,�. \YGZ°4...0`� ` Title Superintendent DOH-1555 (10/89) p. 1 of 2 VS-61