Ball, Bertha NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Bertha M. Ball female
Date of Death Age If Veteran of U.S. Armed Forces,
iipii May 7, 1996 88 War or Dates no
14 Place of Death Hospital, Institution or
Z City, Town or Village Town of Queensbury Street Address Hallmark Nursing Centre
Manner of Death®Natural Cause 0 Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Patricia Hale MD
Address
7240 Upper Broadway, Fort Edward, N. Y. 12828
<> Death Certificate Filed District Number.. Register Number
<a City, Town or Village Town of Queensbury 49 gt
Date Cemetery or Crematory
®Burial May 9, 1996 Pine View Cemetery
Address
n Cremation
Queensbu7•/, N=:!,4 York:
Date ' Place Removed
0 ❑Removal • I and/or Held
r- and/or Address
Hold
Q Date ' Point of
N El Transportation Shipment
a 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. 01583
Address
101 53 Quaker Road, Queensbury, New York 12804
<' Name of Funeral Firm Making Disposition or to Whom
t" Remains are Shipped, If Other than Above
' Address
iU
Permission is hereby granted to dispose of the human r 'ns esc ab a as indicated.
Date Issued . =7 9(.0 Registrar of Vital Statistics 0L.,;- 1
piqi (•sig ature
`> � District Number c-1 Place �t(5�t7� G R ��(,t„
I certify that the remains of the decedent identified above wer disposed,of in accordance wit this p mit on:
t:-
wDate of Disposition 5./9/9_6 Place of Disposition pine Vi ew Cemetery , Oueenshury , NY
2 (address)
New Kenesaw 7 2
LC (section) (lot number) (grave number)
AName of Sexton or Person in Charge of Premises Rodney G. Mosher
g (please print)
44 Signature Title Superintendent
DOH-1555 (10/89) p. 1 of 2 VS-61