The URL can be used to link to this page

Winters, Rose tt NEW YORK STATE DEPARTMENT OF HEALTH I Vital Records Section Burial - Transit Permit Name First Middle Last • Sex Rose M. Winters Female Date of Death Age If Veteran of U.S. Armed Forces, 4/2/2 01 1 95 War or Dates n/a • Place of Death Hospital, Institution or Z• City, Town or Village Town Granville Street Address Indian River Nursing Home Manner of Death®Natural Cause D Accident 0 Homicide 0 Suicide riUndetermined El Pending 11$ Circumstances Investigation Ili Medical Certifier Name Title M x L. Grassr14441J M p . Address , 1 1.2 3,Z_ I`1 NA� d+�15 �, ra.hvtl�e � . Death Certificate Filed District umber Register\lumber City, Town or Village Town of Granville -7a?5— /7 s`< 0 Burial Date Cemetery or Crematory 4/5/2 01 1 Pine View Crematorium • gi❑Entombment Address ,Cremation 21 Quaker Road Queensbury, NY 12804 Date Place Removed Z Removal and/or Held 9❑and/or/or Address Hold fil O Date Point of Transportation Shipment G by Common Destination Carrier El Disinterment Date Cemetery Address liNEl Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan and Denny Funeral Service 01 464 Address 53 Quaker Road Queensbury, NY 12804 Name of Funeral Firm Making Disposition or to Whom 1 ' Remains are Shipped, If Other than Above • Address it lit a" Permission is hereby g anted to dispose of the human rem 'ns dtscr. ab a as indicated. iia Date Issued D © // Registrar of Vital Statistics (signature) < District Number /r r, 5- Place 6.ran i/'`l e N / I certify that the remainsre / of the decedent identified above were isposed of in accordance with this permit on: 2 lU Date of Disposition Li-6 i t Place of Disposition „ 0%.T1,,, C ,.<f ur/tow% 2 (address) lJ Cl) IX (section) a (lot numb A (grave number) • Name of Sexton or Per in Charge of Premises civkopil r So is4'1 ta 2 � (please print) • Signature Title C11t:hi't Ot iii (over) DOH-1555 (02/2004)