Della Rocca, Kathleen NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
s Name First Middle Last Sex
Kathleen Della Rocca female
•
Date of Death Age If Veteran of U.S.Armed Forces, _0
5 0 War or Dates
Z Place of Death Hospital, Institution or
W QitycTowya tar Village Hudson Falls Street Address Hudson River
D Manner of Death Undetermined Pending
Natural Cause Accident Homicide Suicide
Circumstances Investigation
UI Medical Certifier Name Title
p B . Peter Jensen , Coroner/MD
Address
6225 Main St . , Argyle , NY
Death Certificate Filed District Number Register Number
edtgiboweccc Village Hudson F a 1 1 s 5726
Date Cemetery or Crematory
El Burial Ma y 4 , 1992 Pine View Crematorium
€]Cremation Address
Town o:f .Queensbury, NY:,
z Date Place Removed
OI', ❑ Removal and/or Held
F and/or Hold
Address
N
a Date Point of
N ['Transportation by Shipment
p Common Carrier
Destination
...... .... .. ...
❑ Disinterment Date Cemetery Address
El Reinterment
Date .: ::::.: _..:.::..... .:..... Cemetery Address
' Permit Issued to ' Registration Number
Name of Funeral Firm Eannace Funeral Home, Inc . 00596
Address
932 South St . , Utica , NY 13501
1-: Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
� Address
il>
NI Permission is hereby granted to dispose of the human remainsdescribed above as indicated.
tiiii!i. Date Issued May 4, 1992 Registrar of Vital Statistics .�; '. . C{{ �"}'1C�- -�'
(signaturj
District Number 5726 Place Village of Hudson Falls , NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—Z / f
Z Date of Disposition j`J ".oZ Place of Disposition /,Y,e- /- .E4J C/? ET4/1/�'�///f
g (address)
W
NCC' (section) (lot number) (grave number)
°' 9 .0 01.- i y'lt'-17 /l7/5,/�i'9�
p Name of Sexton or erson in Ch a of Premises
Z lease print) e A i
w> Signature Title_ /r��dx� 953
DOH-1555 (10/89) p. 1 of 2 VS-61