Choiniere, Leda NEW PORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
. Name Hist Middle Last Sex
Leda T. Choiniere Female
_ _
Date of Death Age If Veteran of U.S. Armed Forces,
_ 6/8/98 ____ __ 89 War or Dates No
Place of Death Hospital, Institution or
6 City, Town or Village Queensbury Street Address Hallmark Nursing Center
Manner of Death Natural Cause n Accident n Homicide n Suicide n Undetermined n Pending
Circumstances Investigation
Q Medical Certifier Name Title
Robert Beaty MD_
Address
ig.
_ _ 2 Broad st Plaza Glens Falls,NY
Death Certificate Filed District Number ( Regi e,Nurnber
ii City, Town or Village Queensbury 5657 ��
Date Cemetery or Crematory
Burial 6/13/98 St.Alphonsus Cem
r-i Address
LJ Cremation Queensbury,NY •
Date Place Removed
Zn Removal and/or Held
and/or Address
0. Hold .
0 Date Point of
tiai n Transportation Shipment
Gl• by Common Destination
Car►i'?r
n Disinterment Date Cemetery Address '
n R•
einlerrnerrt Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral HomeSullivan-Minahan & Potter 01837
>> Address - - - - - -
_ 407 Bay Rd. Queensbury,NY 12804
'`' Name of Funeral Firm Making Disposition or to Whom
L' Remains are Shipped, If Other than Above
Address
, Permission is hereby granted to dispose of the huma mains desc d bove as indicated.
Date Issued 6/12/98 Registrar of Vital Statis cs (jam
(signature)
<`:. District Number 5657 Place Queensbury,NY
I certify that ll)e Ieniairrs of the decedent identified above were disposed of in accordance will) this permit on:
W Date of Disposition /2��q� Place of Disposition 'Si, #OiV-S ') - QU/off. /j 4?� /W
(address)
sn
W (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises P/9-//I /4o* /oL�jv
z - _-__- (please print) /-
W Signature 00 Title c 641‘ /f' ,#?,'" /n fro 6
DOH-1555 (10/89) p. 1 of 2 VS-61