Cahill, Iman NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
igi Name First Middle Last Sex
Iman L. Cahill M
Date of Death ' Age If Veteran of U.S. Armed Forces,
12-30-97 83 War or Dates 42-44
F Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address GFH
W Manner of Death ❑x Natural Cause ❑Accident ❑Homicide ❑Suicide ri❑Undetermined ❑Pending
Circumstances Investigation
itj
la Medical Certifier Name Title
C. John Rugge MD
Address
HHHN, Warrensburg, NY
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 b I D
Date Cemetery or Crematory
❑Burial 12-31-97 Pine View Crematory
�i Address
L�Cremation Queensbury, NY
Date I Place Removed
0❑Removal and/or Held
L.••- and/or Address
Hold
in
0 Date Point of
N❑Transportation Shipment
a by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Oil Name of Funeral Home Alexander-Baker FH 00018 ,
Address
Warrensburg, NY
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
•
a s
iiiil Permission is hereby granted to dispose of the human remains des ri ed boy as 2 i ica esj.
.
Date Issued 12-31-97 Registrar of Vital Statistics . /i(
''' (signature)
District Number 5601 Place City of Glens Falls, NY
I certify that the remains of the decedent identified above were dispos d of in accordance with this permit on:
W "Date of Disposition ot / ir Place of Disposition Pi/YE- /E . ( Tllia-1 / JAz
(address)
LU
CA
it (section) di�p lot um er (grave number)
0 Name of Sext or Per in Charge of remises �2:2thw D /� /�
W Signature c (pleas Tp Kle_ 2-10 ;(I/9T?) /7`S5- '/J "
DOH-1555 (10/89) p. 1 of 2 VS-61