Austin, Clara -liir
NEW YORK STATE DEPARTMENT OF HEALTH # LU
Vital Records Section
Burial - Transit Permit—
,,,
. Name First Middle Last Sex
Clara Belle Austin Female
Date of Death Age If Veteran of U.S. Armed Forces,
April 14, 2011 98 War or Dates
t�... Place of Death Hospital, Institution or
Z City, Town or Village Granville Street Address Orchard Nursing &Rehab Center
°2 Manner of Death I XI Natural Cause Accident ' 'Homicide Suicide I I Undetermined Pending
Circumstances Investigation
w Medical Certifier Name Title
Q
Address
Death Certificate Filed District Number sr/5 4 1 Register i Number
°� City, Town or Village Granville CD
❑Burial Date Cemetery or Crematory
April 18, 2011 1 Pine View Crematorium
Entombment Address
I Cremation 21 Quaker Road, Queensbury, NY 12804
Date Place Removed
Z —Removal and/or Held
O and/or Address
N Hold
0 -
' Date Point of
N Transportation Shipment _
5 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'7 Remains are Shipped, If Other than Above
, , Address
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• Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued y!t 7 f D I 1 Registrar of Vital Statistics , i cLa-1-3.4,1
Q ) (signature)
1 uJr\cif
District Number 6 r--15L, Place Granville
I certify that the remains of the decedent identified above were disposed, of in accordance� with this permit on:
W Date of Disposition Lt-1rr it Place of Disposition -I'1`y Ut tj 1./ol-vt ors4)—.
S (address)
W
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re (section) i _ (lot'ember) (grave number)
o• Name of Sexton or Person in Charge of P emises i
r,vt Ne tat
Z (please print)
W Signature / 'f1,L. Title
(over)
DOH-1555(02/2004)