Daly, Heather tt
NEW YORK STATE DEPARTMENT OF HEALTH z' S J v
Vital Records Section Burial - Transit Permit
Name First Middle Last S x
Ne i*-v,� DwtV e41-e
Date of Death Age If Veteran of U.S. Armed Forces,
Oc poc' 'a��, o ( `-t L{ War or Dates
H Place of Death /- Hospital, Institution or
Z City, Town or Village G len5 f••=c,11 S Street Address G ►e.,,\s 1=c-,t\S ►-} ' tom;fir,i
Manner of Death El Natural Cause El Accident 0 Homicide D Suicide D Undetermined ri Pending
tit Circumstances Investigation
tu Medical Certifier Name Title r.1
d i yro-thq IM ,,c h\/ `-_cyconeS
Address
'a 1 v• Icncx Ave , Gk ' ccttS, N-q , 19S)oI
Death Certificate Filed f ' District Number Registerp9mber
City, Town or Village V 1-eos rol I\ 5(, 0 I i 6
❑Burial Date Cemetery or Crematory
Entombment I O l h(o D Zc)I I �,ne v;e C-Ce Imt A' ‘ u ill
Address
ECremation •
Date Place Removed
0 a Removal and/or Held
2 and/or Address
N Hold
O Date Point of
NLiTransportation Shipment
ES by Common Destination
Carrier
Disinterment ' Date Cemetery Address
Renterment Date Cemetery Address
Na Issued to / �� J '`� Registratpi__ Numbern
Name of Funeral Home Y
Address �� alien �� ` / ,/ /"Q
Name of Funeral Firm Making Disposition or to Whom �t1
Remains are Shipped, If Other than Above
Address
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` Permission is hereby granted to dispose of the human ains described a ove as indica -d.
Date Issued /o/02 /// Registrar of Vital Statistics
(signa ure)
District Number �6o/ Place 6/MSAV/s 1 r V
II certify that the remains of the decedent identified above w e dis osed of in accordance with this permit on:
Date of Disposition 10 kilt Place of Disposition 'iv Ute..., 64-c10 riur- .
2 (address)
Lu
CA
cc (section) /1 - (lot num (grave number)
i Name of Sexton or P son in Charg b f Premises to trrcit
(please print)
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Signature Title ce m'riro .
• (over)
DOH-1555 (02/2004)
DALY ,,, � Lot No. 18D
Address 5 County Route 41 Hudson Falls, NY 12839
Section NO.
Owner T.pnnard A Daly Plot Erie
Date 3/9/2012
__Appxpx, 1 0 0 Superficial ft. @
Location Rounded on the North by Paculavich, East by Vacant
West by Road and South by Dineen
Corner Posts
Remarks 792-3020
Deed No. (and changes) 3764
Payment Record Paid in full on 3/9/2012 ( ct1 , fion_ on)
Record of Interments
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A D
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2/5 Heather Daly ( 6/29/12 Crem, ) I �z a
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Form No. 01
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14 A M E DALY, HEATHER
Age: 44
Cause: Cremation
Lot Owner: Leonard & Corleen Daly
Lot # 18 D Erie
Grave #2
Case # Marble
Died: 10/24/2011
Interred: 6/29/1012
Undertaker: Regan & Denny