Hoenck, Dorothy NEW YORK STATE DEPARTMENT OF HEALTH * s la
Vital Records Section Burial - Transit vermit
Name First Middle Last Sex
Dorothy Hoenck Female
Date of Death Age If Veteran of U.S. Armed Forces,
March 10,2011 86 War or Dates
Place of Death � P l� Hospital, Institution or
City, Town or Village. Pr1S ``f [ [S I ` Street Address The Pines At Glens Falls
• Manner of Death X Natural Cause Accidents l I [Homicide Suicide Undetermined Pending
19i Circumstances Investigation
us Medical Certifier Nam Title
� _ Address `�
Death CeCrtiCfica e Filed f t District Number Register Number
City, Town or Village Glens Falls,NY 5601 i 1
El Burial Date Cemetery or Crematory
❑Entombment March 11, 2011 Pine View Crematory
Address
❑X Cremation Quaker Road, Queensbury, NY 12801
Date Place Removed
Z Removal and/or Held
Q and/or Address
F_ Hold
Cl)
O Date Point of
N I I Transportation 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
t Remains are Shipped, If Other than Above
a Address
us
, k Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued I/0 l J 1 Registrar of Vital Statistics caw
net~ urL�)(sig
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with
ance with this permit on:
LUDate of Disposition 31 S--1( Place of Disposition 'Pint 1)wrw -fw0rIv",
W (address)
co
cd (section) A - i (lot nuber) (grave number)
pName of Sexton or Person in Char a of Premises f, } e ti
`LJ Z + (please print)
Signature �� Title Cal_ ittDt
(over)
DOH-1555(02/2004)