Littrell, Dawn It 1NEW YORK STATE DEPARTMENT OF HEALTH ( b/
Vital Records Section Burial - Transit Permit 1
• Name First Middle Last Sex i
Dawn Littrell Female
Date of Death Age If Veteran of U.S. Armed Forces,
April 1, 2012 73 War or Dates
Place of Death Hospital, Institution or
'Z City, Town or Village Queensbury Street Address 50 Old Mill Lane
pManner of Death I XI Natural Cause ' Accident Homicide Suicide Undetermined Pending
w Circumstances Investigation
u Medical Certifier Name Title
Pi Robert Sponzo,MD
Address
102 Park Street Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
• e City, Town or Village Queensbury � .-'-1 4 Li
❑Burial Date Cemetery or Crematory
April 3,2012 Pine View Crematory
❑Entombment Address
El Cremation Quaker Road
Date Place Removed
Z [ I Removal and/or Held
O and/or Address
H Hold
N
O Date Point of
N I I Transportation Shipment
a by Common Destination
Carrier
I Disinterment Date Cemetery Address
I
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Funeral Home 01443
Address
53 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
F Remains are Shipped, If Other than Above
2 Address
0
Permission is hereby granted to dispose of the human remains described above asundicated.
Date Issue }
t3 <=-01�, Registrar of Vital Statistics Q.. C f- - �--- .
� r (signature)
District Number SCQc--h Place Queensbury
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition Afr,i N Za it Place of Disposition ,P„IU . Covit i„N.
(address)
Ill
U)
CL
O (section) (lot number)r (grave number)
p Name of Sexton or Person in Charge f Premises Aosillirt.w
Z (please print)
�,�}
W Title eatEtli IOC
Signature V
(over)
DOH-1555(02/2004)