Hull, Dorothy ' I t'i'Yr.. 14-,e.t- t -. N
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
<': Name First Middle Last Sex
Dorothy L. Hull female
€> Date of Death Age If Veteran of U.S. Armed Forces,
>I>< Dec._ 4, 1997 83 War or Dates no
I Place of Death Hospital, Institution or
City, Town or Village City of Glens FallsStreet Address Glens Falls Hospital
Manner of Death Natural Cause Accident Homicide Suicide Undetermined. El Pending
Circumstances Investigation
kJ Medical Certifier Name Title
fl David W. Schwenker MD
Address
90 South St. , Glens Falls, NY 12801
>:. Death Certificate Filed District Number Register Number
>' City, Town or Village City of Glens Falls `5--6/
Date Cemetery or Crematory
®Burial Mount Hermon Cemetery
Address
:i:: ❑Cremation Queensbury, New York 12804
Date Place Removed
2 a Removal Dec. 8,1997 and/or Held Pine View Cemetery Vault
and/orliTi Address
Hold Queensbury; New York 12804
0 Date Point of
(i)Li Transportation Shipment
5 by Common Destination •
Carrier
Disinterment Date Cemetery Address
(Li Reinterment
mate Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan and Denny Funeral Home 01565
iiiiili
s; Address
53 Quaker Road, Queensbury, NY 12804 •
Name of Funeral Firm Making Disposition or to Whom
'" Remains are Shipped, If Other than Above
IAddress .
a
:::::: Permission is hereby granted to dispose of the human remains describ d a
ovv s i is to .
ip Date Issued /2- S q ? Registrar of Vital Statistics /G�'
(signature)
Mii District Number 3 2$Q/ Place /"eik.,a ///5; ,VX
certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
.1
5 Date of Disposition 4/25/98 Place of Disposition Mt . Hermon Cemetery ,Queens bury .NY
2 (address)
ilj
Family Plot
CC (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises Rodney G Mosher
F (please print)
Signature r__) ..ty,A : ,c,,i"*' k, Title Superintendent
DOH-1555 (10/89) p. 1 of 2 VS-61