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Vorosmarty, Tivadar
NEWYORK STATE DEPARTMENT OF HEALTH Burial- Transit Permit Bureau of Vital Records Name First Middle Last Sex Tivadar Vorosmarty Male Date of Death Age If Veteran of U.S.Armed Forces, 11/14/2019 88 Years War or Dates Place of Death Hospital,Institution or City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation ups Mannerof Death Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title Gwendolyn Moms-Dickinson PA Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 490 ©Burial Date Cemetery,Crematory or Facility Name 11/20/2019 Pine View Cemetery ❑Entombment Address ❑Cremation Queensbury Town,New York Donation Removal Date Place Removed and/or and/or Held Hold Address Transportation Date Point of by Common Shipment Carrier Destination . Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 'y 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address A Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/18/2019 Registrar of Vital Statistics !RpA" ndhewCurrzr(-Yectvni7aQySrgsreQ) /signature/ District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F Z Date of Disposition 1 112 0 12 D 19 Place of Disposition /address LLI 1 2 (sectan) (lot number) (grave number) Name of Sexto or Person in Charge of Premises Connie L. Goedert (please print) W Signature Title Cemetery Superintendent DOH-1555(07/18)p t of 2 Vorosmarty NAME Age: Tivador Vorosmarty gg Lot Owner: Tivador Vorosmarty Lot# Horicon 1 2-G Grave# 1 CaseConcrete Died: 11 /1 4/201 9 1 1 /20/201 9 Funeral Home: Regan Denny Stafford Cemetery: Pine View I it I I' Public Health Law Sec. 4145(2b) 010353 Receipt Human remains of -`d" -' r�'- delivered on_.A,L Z , 20 Pine View Cemetery Representing the funeral home name rd sop burial permit ,l Official _,' Funeral Directors Reg.or License# 4 4 __.