Mease, Laura .
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
.fr Name First Middle Last Sex
,.` ' Laura Elizabeth Mease Female
r�r Date of Death Age If Veteran of U.S. Armed Forces,
July 19, 2014 71 War or Dates
? Place of Death
'':X..
Hospital, Institution or
City, Town or Village Hudson Falls Street Address 7B River Street
Manner of Death !xi Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Robert Reeves Dr.
Address
f;3 Irongate Center,Glens Falls,NY 12801
' Death Certificate Filed District Number Register Number
City, Town or Village Village of Hudson Falls 5 7 DC, lI
❑X Burial Date Cemetery or Crematory
July 22, 2014 Pine View Cemetery
❑Entombment Address
0 Cremation Quaker Road, Queensbury, ,NY 12804
Date Place Removed
ZZ I I Removal and/or Held
and/or Address
—1— Hold
N
Q Date Point of
NTransportation Shipment
6 by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
j. Permit Issued to Registration Number
:: Name of Funeral Home Regan Denny Stafford Funeral Home 01443
xi Address
4� 53 Quaker Road, Queensbury, NY 12804
; Name of Funeral Firm Making Disposition or to Whom
1'.'r Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human rerpain escribed above as indicated.
:::
Date Issued 7-Dl --` °"V Registrar of Vital Statistics
(signature)
't:i; District Number 5 7 (o Place Village of Hudson Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 7/22/1 4 Place of Disposition Pine View Cemetery
W Huron 8 I (address) 1
CO
CL (section) (lot number) (grave number)
O Name of Sexton or Person in Charge of Premises Connie L. Goedert
W Super in a tnt
Signature Title
(over)
DOH-1555(02/2004)