Lattin, Elizabeth }
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NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Elizabeth A. Lattin Female
Date of Death Age ' If Veteran of U.S. Armed Forces,
January 23, 2011 75 War or Dates
f Place of Death ; Hospital, Institution or
Z City, Town or Village Queensbury j Street Address Westmount Health Facility
pManner of Death X Natural Cause I I Accident Homicide Suicide Undetermined Pending
111 Circumstances Investigation
ui Medical Certifier Name Title
:0 Bernardo Villajuan MD
Address
88 Broad Street,Glens Falls,NY 12801
Death Certificate Filed District Number Re ' ter Number
'' City, Town or Village Queensbury 5657
❑Burial Date Cemetery or Crematory
January 28, 2011 Pine View Crematorium
❑Entombment Address
ID Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
E Hold
Cl)
0 Date Point of
NTransportation I Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment
Date ; Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan& Denny Funeral Home 01464
Address
53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
N- Remains are Shipped, If Other than Above
F Address
IBC
AU
.0. Permission is hereb granted to dispose of the human rema'ns described ove as indicated.
Date Issued O Registrar of Vital Statistics c , 8 AA
(signature)
District Number 5657 Place Queensbury
▪ I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition FEB 2d11 Place of Disposition {)„n iIt.) Crtim<f vr-it,n�
W t (address)
CO
CC (section) (lot nu er) (grave number)
a Name of Sexton or Person in Char of Premises /j
p 9 G I.r,5iv�1�Itr t4nt�l
W (please print)
Signature al,,k_ Title C 2c A krog.
(over)
DOH-1555(02/2004)