Sleight, Dorothy NEW YORK STATE DEPARTMENT OF HEALTH
/tat Records Section Burial - Transit Permit;
Name First Middle Last Sex
Dorothy E. Sleight Female
Date of Death Age If Veteran of U.S. Armed Forces,
08-22-2012 90 War or Dates n/a
Place of Death Hospital, Institution or
W City, Plattsburgh, NY Street Address 8 Durand Street
a Manner of Death LE1771 Natural Cause 0 Accident El Homicide El Suicide 0 Undetermined ri Pending
W Circumstances Investigation
W Medical Certifier Name Title
G Dr. Lutinski M.D
Address
Plattsburgh, NY 12901
Death Certificate Filed District Number Register Number
ity, TISKEMOTAtii12042C Plattsburgh, NY 901
urial Date Cemetery or Crematory
08-27-2012 Pine View Cemetery
❑Entombment Address
OCremation Glens Falls, NY
Date Place Removed
Z El Removal and/or Held
C and/or
Address
�
E Hold
61
0 Date Point of
Q Transportation Shipment
0 by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Haw. 01443
Address
53 Quaker Rd, Queensbury, NY
Name of Funeral Firm Making Disposition or to Whom
I- Remains are Shipped, If Other than Above
2 Address
I
W
1 Permission is he eby ranted to dispose of the human ains described above as i dicated.
Date Issued 2r,;j, ! Registrar of Vital Statisti /'
(signature) /
District Number 901 Place City f Plattsburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
gDate of Disposition 8/27/1 2 Place of Disposition Pine View Cemetery
W (address)
11 Horicon 5F 2
CC (section) (lot number) (grave number)
p Name of Sexton or Person91J.M. s
" Charge of Premises Michael Genier
Z °1 _ '—'1 (please print)
Signature Title Superintendent
(over)
DOH-1555 (02/2004)