Amir, Lenore I : 1 if a-)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Lenore Amir Female
Date of Death Age If Veteran of U.S. Armed Forces,
10/14/2018 86 War or Dates _
F Place of Death Hospital, Institution or
Z City, Town or Village Queensbury Street Address 38 Lyon Ct
0 Manner of Death in Natural Cause n Accident ❑Homicide Suicide ❑Undetermined n Pending
tti Circumstances Investigation
w Medical Certifier Name Title
C Glen Anderson
Address
161 Carey Road,Queensbury,NY 12804
Death Certificate Filed Djstrict Number R ister Number
City, Town or Village ( Th 1
❑Burial Date Cemetery or Crematory
❑ October 16, 2018 Pine View Crematory
Entombment Address
®Cremation Quaker Road,Queensbury,NY 12804
Date Place Removed
Z n Removal and/or Held
and/or Address
H Hold
CJ)—
O Date Point of
y ❑Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
• Remains are Shipped, If Other than Above
2 Address
te
O.
Permission is hereby granted to dispose of the human r m 'ns desc ' ed ; as indicated.
Date Issued 10 \t t4 I h V Registrar of Vital Statistics°'" e.-t. ( a '�1'"
D
(signature)
District Number c(d'Th Place ` O ,t--,- . o-c a , 0
I certify that the remains of the decedent identified above were disposed of in accardanc- with this permit on:
W Date of Disposition It ll6 111 Place of Disposition AU.-- raJrL-
W (address)
CO
CL (section) go!number) ���� (grave number)
pName of Sexton or Person in Charge of Premises
Z (ple a print)
Signature 16— Title ( APcnz,/L,
(over)
DOH-1555(02/2004)