George, Helen NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last 1 Sex
HELEN GEORGE FEMALE
iBi Date of Death Age If Veteran of U.S. Armed Forces,
JULY 9, 1998 81 War or Dates
Place of Death Hospital, Institution or
Z City,XTOMXXXXCAW GLENS FALLS Street Address 11 ONEIDA STREET
in Manner of Death F,Natural Cause lElAccident El Homicide El Suicide C Undetermined Pending
lli Circumstances Investigation
ita Medical Certifier Name Title
PHILIP J. .GARA, MD
Address
ali 318 BROADWAY, FORT EDWARD, NY 12828
Death Certificate Filed District Number Register Number
City, NVXXi D(XlXQl D4 GLENS FALLS 5601 3,--,p
Date Cemetery or Crematory
: El Burial JULY 11, 1998 PINE VIEW CEMETERY
Address
..D_Cremat�.an -- QUAKER ROAD, QUEENSBURY, f t-i2 O4
Date Place Removed
g❑Removal and/or Held
tt, and/or Address
67 Hold
Q Date Point of
NQ Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Nil Permit Issued to Registration Number
111 Name of Funeral Home REGAN AND DENNY FUNERAL HOME 01565
Address
53 QUAKER ROAD, QUEENSBURY, NY 12804 •
Name of Funeral Firm Making Disposition or to Whom
14
Remains are Shipped, If Other than Above
Address
L.1
A---
ni Permission is hereby granted to dispose of the human remains describe above a i dicated.
Mi Date Issued L C9 79f Registrar of Vital Statistics yz_� -7 /- O7'- __
ature)
I>: District Number v / Place •
JAW
__,,,&-et/r.J tj '.I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
f-
W Date of Disposition 7/11/98PIace of Disposition Pine View Cemetery , Queensbury , NY
(address)
Mohican 49-A 2
C (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises Michael Lopez
(please print)
Signature Title Working Foreman
DOH-1555 (10/89) p. 1 of 2 VS-61