Strausser, Louis NEW YORK STATE DEPARTMENT OF HEALTH } 3-1e'
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
::X Louis A. Strausser Male
err Date of Death Age If Veteran of U.S. Armed Forces,
May 22, 2015 79 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death
X Natural Cause Accident Homicide Suicide Undetermined Pending
gi
Circumstances Investigation
Medical Certifier Name Title
P, Suzanne Bergin,MD
Address
3767 Main Street,Warrensburg,NY 12885
iX Death Certificate Filed District Number Register Number
:`.® City, Town or Village 5 6 o I 'a-I)
❑Burial Date Cemetery or Crematory
May 26, 2015 Pine View Crematory
❑Entombment Address
❑x Cremation Quaker Road, Glens Falls,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
F_ Hold
Cl)
0 Date Point of
u) Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
:aPermit Issued to Registration Number
: Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
:::*: 53 Quaker Road, Queensbury,NY 12804
:::: Name of Funeral Firm Making Disposition or to Whom
+; Remains are Shipped, If Other than Above
Address
::•.: Permission is hereby granted to dispose of the human remains described above as indicated.
A Date Issued 5/2.6 J i' Registrar of Vital Statistics Wek. .A.).
:i (signature)
@` : District Number 5 b Q 1 Place t (siAIN5 P.A11 5 /
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
z W Z� ZZit, C �Date of Disposition S� ,1�' Place of Disposition �
W (address)
CO
0 (section) (lot number) (grave number)
QName of Sexton or Person in Charge of Premises number)„,
W e (please print)
Signature (/(fir Title Car/moil-it
(over)
DOH-1555(02/2004)