Katz, Elizabeth NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle
Elizabeth Last Sex
Date of Death Katz Female
May 1, 1999 Age If Veteran of U.S. Armed Forces,
Place of Death 71 War or Dates
Hospital, Institution or
'.�..` City, Town or Village Queensbury Street Address 10 Dixon Court
Manner of Death Natural Cause Accident Homicide Suicide
.: Undetermined Pending
ill Medical Certifier Name Circumstances Investigation
Title
David Schwenker MD
Address
90 South Street, Glens Falls, New York 12801
Death Certificate Filed Distr' Nu b r
City, Town or Village Queensbury b Register Number
Date Cemeteryor Cremato ��
0 Burial ry
Pineview Cemetery
Address
❑Cremation Quaker
Road, Queensbury, N.Y.
g Date Place Removed
❑Removal
N and/or Address and/or Held
a Hold
Date Point of
y Q Transportation
Shipment
3 by Common Destination
Carrier
Ei
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
iiiiPermit Issued to Registration Number
. Name of Funeral Home Regan & Denny Funeral Service 01565
Address
53 Quaker Road, Queensbury, N.Y. 12804
i. Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
"" Permission is hereby granted to dispose of the huma ains des ed a o e s indicate..
MI
Date Issued S--9--Ql Registrar of Vital Statist. -s %l.� Q ,
(si•n
District Number SCo Place 4'
ervo\-_ A fLy0
I certify that the remains of the decedent identified above w: , disposed of in accord.,nce with this ermit on:
f
5 Date of Disposition 5/5/99 Place of Disposition Pi - View Cemetery , Queensbury , NY
2 (a..ress)
N Hudson #1 5-G 1
c (section) (lot number) (grave number)
0 Name of Sext.•- • Person in Charge of Premises Rodney G C . Moshe r
g (please print)
Signature ,ram!`, ,_ AA L Aar .7_ Title Superintendent
(over)
DOH-1555 (9/98)