Rohne, Joan NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
iilil Name First Middle Last • Sex
Joan M. Rohne female
€€ Date of Death Age If Veteran of U.S. Armed Forces,
gg Nov. 14, 1997 • 64 War or Dates no
•
Place of Death Hospital, Institution or
2 City, Town or Village Town of Queensbury Street Address 8 Cedarwood Drive,
Manner of Death Ljr1t1 Natural Cause 0 Accident 0 Homicide El Suicide ❑Undetermined ri Pending
Circumstances Investigation
Medical Certifier Name Title
Christopher Hy MD
Address
102 Park St. , Glens Falls, NY 12801
iii: Death Certificate Filed District Number Register_Number
>i City, Town or Village Town of Queensbury S-(� f--� 1 Q�
Date Cemetery or Crematory
®Burial Nov. 19, 1997 Pine View Cemetery
Address
❑Cremation Queensbury, NY
Date Place Removed
0 1-7 Removal and/or Held
IF- and/or Address
5 Hold •
Q Date Point of
NQ Transportation Shipment
. .a by Common Destination
Carrier
0 Disinterment Date I Cemetery Address •
Date Cemete y A:-d:ass
❑Reinterment
Permit Issued to Registration Number
Ri Name of Funeral Herne Regan and Denny Funeral Home 01565
tiiiiii Address
53 Quaker Road; Queensbury, NY 12804
ME
M: Name of Funeral Firm Making Disposition or to Whom
m im Remains are Shipped, If Other than Above
Address
iiiiiiiii Permission is hereby granted to dispose of the human remains described above as indicated.
>>! Date Issued l i I i )9 Registrar of Vital Statistics r->'1 ;a .,sk..Q,,
(signature) v
i!iiiii! District Numb s) Place -3 l___C`�� CIL 4r:::)+) i
I certify that the remains of the decedent identified above were disposed of in acco ance with this permit on:
i-
6 Date of Disposition 11/19/97 Place of Disposition Pine View Cemetery , ueensbury,NY
W (address)
N Huron 10-B 8
CC (section) (lot number) (grave number)
osName of Sexto r Person in Charge of Premises Pod ne N7 (, Mr, h P r
g ) (please print)
t4 Signature 4 .2,,,,t2„ Ali Z . .s.. Title Si PPri ntPndent
. .
DOH-1555 (10/89) p. 1 of 2 • VS-61