Steves, Lois NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Lois J. Steves Female
Date of Death Age If Veteran of U.S. Armed Forces,
December 27, 2011 84 War or Dates
�.: Place of Death Hospital, Institution or
'Z City, Town or Village Queensbury Street Address Westmount Health Facility
pManner of Death X Natural Cause Accident }Homicide Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
G Roslyn Sccolof, MD
Address
42 Gurney Lane,Queensbury,NY 12804
Death Certificate Filed f Dis_tr.irst Number ! Riegis e r Number
City, Town or Village Queensbury
0 Burial Date Cemetery or Crematory
December 30, 2011 ; West Glens Falls Cemetery
❑Entombment Address
❑Cremation Corinth Rd, Queensbury, NY 12804
Date Place Removed
ZZ Removal and/or Held
and/or Address
H Hold
O Date Point of
0 Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
'n Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Funeral Home 01443
Address
_53 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped, If Other than Above
Address
EL
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued I�2i� ) f QC) i/ Registrar of Vital Statistics ` yyL� R.t�
(signature)
District Number S�C r> Place Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 1 2/30/1 1 Place of Disposition West Glens Falls Cemetery
W (address)
Steves Family Lot
(section) (lot number) (grave number)
QName of Sexton or Person in Charge of Premises Michael Genier
Z (please print)
W Signature Q<"""` '1` r .wA- Title Superintendent
(over)
DOH-1555(02/2004)