Daniels, Sarah NEW YORK
STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section Last
Middle Daniels
Name First Y.
111111111111
Sarah If Veteran of U.S. Armed Forces,
Date of Death 12/06/1998 Age 89 War or Dates no
Hospital, Institution or
City, of Death Glens Falls Street Address Eden Park Nursing Home❑Pending
b City,A�61�D�Cd�rXy(►� �� Suicide Undetermined
i� Manner of Death
X Natural Cause Accident Homicide Undetermined
Investigation
Title
` Medical Certifier Name
Robert Evans, MD
.. Address``< Death Certificate Filed Glens Falls, NY 12801
3 Irongate Ce pistrict Number Register Number
5601 617
': City,7Q4 i iJ(�6rX�X► ;� a Glens Falls Cemetery or Crematory
Date 1998 Pine View Cemeter
:� �: ®Burial 12/10/
Address Uednsbury, NY
Cremation Quaker Road, Q Place Removed
Date and/or Held
F Removal
❑and/or Address
Hold
Date Point of
Shipment
cA Q Transportation
: by Common Destination
Carrier Date Cemetery Address
Li Disinterment
Date
Cemetery Address
.: 0 Reinterment Registration Number
01565
ii-
Permit Issued to Regan & Denny Funeral Home
'�. Name of Funeral Home
Address NY 12804
53 Quaker Road, Queensbury,
M. Name of Funeral Firm Making Dt spoanAbone sition or to Whom
Remains are Shipped, If Other
Address
ranted to dispose of the human remains desc ibed above a indi d.
sn:
hi
Permission is hereby g
: Date Issued 12/10/1998 Registrar of Vital Statistics (signature)
5601 Place it f
.>' District Number
he decedent identified above were disposed of in accordance with this permit on:
I certify that the remains of t Q u e e n s b u r NY
g12 9 8 Place of Disposition. Pine View Cemeter ,
Date of Disposition /10 8 (address) 2
Oneida 186
(/) (section)
(lot number) (grave number)
0 Name of Sex •• or Person in Charge of Premises (please print)
Rone G Mosher
� \ Title Su erintendent
ILI
r r lima* A_, —
Signatu V �.
VS-61
DOH-1555 (10/89) p. 1 of 2