Sabin, Lydia NEW YORK STATE DEPARTMENT OF HEALTH,. f 3 3 4
Vital Records Section - l- Burial - Transit Permit
Name First Middle Last Sex
LYDIA SABIN Female
Date of Death PAge If Veteran of U.S. Armed Forces,
June 29, 2011 I 73 War or Dates n/a
1. Place of Death Hospital, Institution or
City, Town or Village Glens Falls, NY Street Address Glens Falls Hospital
ct Manner of Death Natural Cause Accident 0 Homicide 0 Suicide ri Undetermined Ei Pending
0 Circumstances Investigation
to Medal Sertase ifie� Dame Title
1 i ti,
Address •
Glens Falls, NY
<': Death Certificate Filed Glens Falls, NY District Number 5601 Register Number
City, Town or Village
❑Burial DateJuly 5, 2011 Cemetery or Crematory Pine View Crematory
❑Entombment Address
Cremation Qua*ter Road, Queensbury, NY
Date Place Removed
❑Removal and/or Held
and/or Address
too
— Hold
41)
0 Date Point of
fiti
to❑Transportation Shipment
C by Common Destination
Carrier
?> Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Sullivan-Minahan & Potter Funeral Home 01675
iN Address
407 Bay Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
tip
it
Permission is hereby granted to dispose of the human remains described above-e as'ndi
7/3/11Date Issued Registrar of Vital Statistics i�'��' .(signature)
District Number 5601 Place City of Glens Falls, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
k
ui Date of Disposition 1-1-it Place of Disposition PINV ItJ (, rh,AfOR 16,�
2 (address)
w
to
cc (section) (lot ber) (grave number)
ci Name of Sexton or P on in Char of Premises (: Art ii-
(please print)
i Signature Title CqE N!!'}[ot-
(over)
DOH-1555 (02/2004)