Loading...
Tulloch, Martha J 3 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Martha A. • Tulloch female Date of Death 2/6/2 011 Age If Veteran of U.S. Armed Forces, War or Dates n/a • Place of Death Glens Falls Hospital, Institution or Glens Falls Hospital Z City, Town or Village Street Address Manner of Death LT Natural Cause 0 Accident El Homicide El Suicide El Undetermined 0 Pending ILt Circumstances Investigation W Medical Certifier Name Title Suzanne Blood MD Address 14 Manor Dr Queensbury NY -: Death Certificate Filed Distr� O�' \ Regc r�l ber City, Town or Village Glens Falls I\\ ❑BUflal Date Cemetery or Crematory, 2/8/2011 Pine View Crematroy ['Entombment Address . iiIiiii3Crernation Queensbury , NY Date Place Removed Removal and/or Held ❑and/or t Hold Address 4 0 Date Point of tall" Transportation Shipment 5 by Common Destination Carrier Q Disinterment Date Cemetery Address Q Reinterment Date Cemetery Address • Permit Issued to Registration Number Name of Funeral Home Regan and Denny Funeral Home 01464 Address Queensbury, NY Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address IX ILI Permission is hereby granted to dispose of the human remains described a ove G 'cated. / Date Issued ©2 C/20// Registrar of Vital Statistics 44,1 •. (signature) District Number �(�/ Place /� 6, A mii >>::: I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 2 (� ILI Date of Disposition rt(3 io l Zeti Place of Disposition 1',.0 Vitw Cr ir,.Stvt,u,n, 2 (address) ILI tfl CC (section) (lot number) (grave number) Name of Sexton orPerson in Charg f Premises �11 r:)w?�te r- -t n,ult- lease print) ,„„,,„,, Signature Title (fl t<111 A-10f-- . (over) DOH-1555 (02/2004)