Anderson, Charles �N��E�W P,�ORK STATE DEPARTMENT OF HEALTH
4%jHecords Section Burial - Transit Permit
Name First Middle Last ' Sex
Charles D. Anderson Male
Date of Death ' Age If Veteran of U.S. Armed Forces,
August 8, 1998 82 War or Dates WW 2
14 Place of Death I Hospital, Institution or
Z City, Town or Village Town of Queensbury Street Address 9 Leisure Lane
GManner of Death XX Natural Cause E Accident ❑Homicide ❑Suicide 0 Undetermined C Pending
itl Circumstances Investigation
Medical Certifier Name Title
G William Tedesco MD
Address
17 Pine Street Glens Falls, NY 12801
Nii Death Certificate Filed District Number Register Number
City, Town or Village Town of Queensbury (05-1/ 2 c1
Date Cemetery or Crematory 7
❑Burial August 10, 1998 Pine View Crematory
Address
::: Cremation Quaker Road Queensbury, NY 12804
FDate Place Removed
1❑Removal and/or Held
-- and/or Address
Hold
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
Name of Funeral Home Regan & Denny Funeral Service 566
giiii Address
53 Quaker Road Queensbury, NY 12804
mii Name of Funeral Firm Making Disposition or to Whom
'-•" Remains are Shipped, If Other than Above
Address
iig
» Permission is hereby granted to dispose of the human re 'hs described above indicated.
iiini Date Issued g-- G3 — 2a Registrar of Vital Statistics )"L
(signature)
giiii District Number cLos ? Place L -' —__
I certify that the remains of the decedent identified above were dispo ed of i accordance with this permit on:
W Date of Dispositions!�"AI Place of Disposition//1,, ,(,L� Liric24/I F1 /d42
2 (address)
iLl
fin
IX (section) (lot n ber./(44)(grave number)
GName of Sexton or Perso. in Charge of Premises J27kJ/9J17 /0/7
g (please pant) /i ,-` 17
Signature Title 5 l /
DOH-1555 (10/89) p. 1 of 2 VS-61