Ortez, Pierre NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
iio Pierre A. 0rtez male
Date of Death Age • If Veteran of U.S. Armed Forces,
07/02/1999 41 War or Dates n/a
# P• lace of Death Hospital, Institution or
Xmtx Town ii(d@(iilkitiXX Queensbury Street Address 85B Robert Gardens South _
Manner of DeathLAi Natural Cause �Accident �Homicide �Suicide Undetermined Pending
Circumstances Investigation
M• edical Certifier Name Title
;O P. Bachman, MD
. Address
Warrensburg Health Ceneter, Warrensburg, NY
Death Certificate Filed District Number Register i Number
iini )CO, Town d maw Queensbury 5657
Date Cemetery or Crematory
::: ®Burial 07/08/1999 St. Alphonsus Cemetery
.;.:.
Address-
Cremation
a._sr?hu_ry, NY 1 $04
Date Place Removed
0ni Removal and/or Held
•— and/or Address
ig Hold
0 Date Point of
ti Q Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
gi Permit Issued to Registration Number
iiii Name of Funeral Home Regan & Denny Funeral Home 01594
Address
53 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
'" Remains are Shipped, If Other than Above
Address •
al
I< Permission is h reby granted to dispose of the human re ains described a e as indicated.
Ei Date Issued (I �lcl Registrar of Vital Statistics --,:U„ e h,4./\
ll! " nature)
District Number D� Place l.`� _ , al _ . - -•
I certify that the remains of the decedent identified above - disposed of in accorda - th this permit on:
f-
WDate of Disposition /�9 Place of Disposition 5 'z'he®N-S‘)S ' , /z,5 f G4-4-," /4-,7
, � y /
� �� eau VP.--(address) j?� ��oZ �z
CC (se tion) (lot number) (grave number)
GName of Sexton or Person in Charge of Premises pl9.4-v%`D ?0111 13 I-/ f�'
g (please print) /
414 Signature GAL t Title i M r T='�� Al N ��` re
i
(over)
DOH-1555 (9/98)