Serlin, Howard NEW YORK SyATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Howard H. Serlin Male
Date of Death Age If Veteran of U.S. Armed Forces,
May 11, 2011 97 j War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Mt
' Manner of Death Undetermined Pending
� � �Natural Cause � �Accident Homicide [ Suicide
Circumstances Investigation
to Medical Certifier Name Title
Christopher Hoy MD
, Address
102 Park Street Glens Falls,NY
Death Certificate Filed District Number j Register lumber
City, Town or Village Glens Falls 5601 9
El Burial Date Cemetery or Crematory
E.
Entombment May 13, 2011 Pine View Cemetery
Address
❑Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z I I Removal and/or Held
and/or Address
F' Hold
N
0 Date Point of
a.
N Transportation Shipment
6 by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan& Denny Funeral Home j 01464
Address
53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
I_- Remains are Shipped, If Other than Above
2 Address
CC
JAL
D. Permission is hereb granted to dispose of the human re ains d cribed a ove as ind' ate .
Date Issued5- de Registrar of Vital Statistics
(signature)
District Number 5601 Place Glens Falls rd
I certify that the remains of the decedent identified above wee disposed of in accordance with this permit on:
W Date of Disposition 2/13/11 Place of Disposition Pine View Cemetery
2 (address)
N Adirondack 2&15 1
Qre (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises Michael Genier
(pease print)
Z _ f
W Signature ` �91 Title Superintendent
(over)
DOH-1555(02/2004)