Huot, Elmina NEW YORK STATE DEPARTMENT DFHEALTH ��NN�~��� = ���������^� �����N��^�
Vital Records Section
��~~" m~~m ° � �=��=~°~ Permit
Name First Middle Lost Sex
Elmina E. Huot female
Date of Death teran of U.S.Armed Forces,
February 1, 1992 98 War or Dates no
Z I Place of Death Hospital, Institution or
:.W, City,Town or Village City of Glens Falls Street Address Glens Falls Hospital
11, Manner of Death [K] Natural Cause Accident [:] Homicide [:] Suicide
Circumstances Investigation
Medical Certifier Name Title
Address
Death Certificate Filed District Number Register Number
City,Town or Village City of Glens Falls
Date Cemetery or Crematory
Fj Cremation Address Queerisbury, New York 1260-4
z Date Place Removed
LD Removal and/or Held
CL Date Point of
Lo E]Transportation by Shipment
Destination
---------------.................-���------------------------------. � --������e------------------------------------------------
ElDisinterment �� Cemetery
���������^-.'����^ ����� ...1-11 ������������...�����������.
� El Rointonnont --- Cemetery Address
Permit Issued to Registration Number
certify01602
Name of Funeral Firm Regan and Denny...Funexal...$or.y.i.c.e..,.,Inc..............
Address
26 Quaker Road, Queensbury, New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
...... Permission is hereby granted to dispose of the human mai desc ' ed b as indicated.
172
ate Issued ez Registrar of Vital Statistics
Place
District Number
rdance with this permit on:
Queensbury, 0Y 12904
Date cfDisposition 5/2/92 Place ofDisposition St. Alpb000uo Cemetery, Corner Luoerzoe Id. & Pine St.
LU
Section `'&" 26 1
(section) (lot number) (grave number)
cc
Name ofSaxoo or Person inCh iaes Joseph A. DaIletta
�� '/ (please print)
� �
Signature � Th|a Pastor
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