Teel, Leone NEW YORK STATE DEPARTMENT OF HEALTH It 131
Vital Records Section Burial - Transit Permit
Name First Middle Last 1 Sex
Leone J. Teel 1 Female
Date of Death Age If Veteran of U.S. Armed Forces,
March 13, 2011 82 War or Dates
Place of Death Hospital, Institution or
.Z City, Town or Village Argyle j Street Address 179 Dutch Town Road
aManner of Death X Natural Cause [ 'Accident 1 [Homicide Suicide I ]Undetermined —Pending
W Circumstances Investigation
W Medical C-NN 1)0 e'OC TICtC, MO Title
Addres t
Death Certificate Filed District Number , Register N tuber
City, Town or Village Argyle,NY 5 Z 1 / 7
LI Burial Date Cemetery or Crematory
❑Entombment March 17, 2011 Pine View Crematory
Address
0 Cremation Quaker Road, Queensbury NY 12801
Date Place Removed
Z I 'Removal and/or Held
and/or Address
E Hold
N i
0 Date Point of
W [ I Transportation Shipment
p by Common Destination
Carrier
n 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
1+- Remains are Shipped, If Other than Above
2 Address
W
0. Permission is hereby granted to dispose of the human re 'ns described abo e as indicated.
Date Issued %Li /i Registrar of Vital Statistics c-ck1 L 4' J
(signature)
District Number Place Argyle,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 3'1l-(1 Place of Disposition 'f?flfbL,L) Cr.w1K,'s.-
W (address)
Cl)
0 (section) (lot np fiber) (grave number)
p Name of Sexton or Person in Charg of Premises 6 f,r, 0 ,. .1./tr
z (please print)
Signature /IV, Title C�FMATGL
(over)
DOH-1555(02/2004)