Heinrich, Lena It
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Lena Mary Heinrich 1 Female
Date of Death Age If Veteran of U.S. Armed Forces,
February 25, 2012 80 War or Dates
Place of Death Hospital, Institution or
:Z City, Town or Village Moreau Street Address 35 Spier Falls Road
ei Manner of Death X Natural Cause I 'Accident I i Homicide Suicide Undetermined -Pending
1:f Circumstances Investigation
uj Medical Certifier Name Title
p Christopher Hoy,MD
Address
Glens Falls,NY
::: Death Certificate Filed District Number Register Number
,: City, Town or Village Town of Moreau,NY
❑Burial Date Cemetery or Crematory
❑Entombment February 29, 2012 Pine View Crematory
Address
0 Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z I I Removal , and/or Held
o and/or Address
E Hold
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a Date Point of
N I 1 Transportation , Shipment
a by Common Destination
Carrier
I Disinterment Date i Cemetery Address
I
Reinterment Date Cemetery Address
Permit Issued to Registration Number
:: Name of Funeral Home Regan& Denny Funeral Home 01444
Address
F; 94 Saratoga Avenue, South Glens Falls,NY 12803
Name of Funeral Firm Making Disposition or to Whom
ice Remains are Shipped, If Other than Above
Address
awif
Permission is hereby granted to dispose of the human rem 'ns described above a 'ndicated.
Date Issued 40,4-a A0/2. Registrar of Vital Statistics 621-t—er
signature)
District Number 5��. Place Town of Moreau,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
LU Date of Disposition r.t..KL ( ( tr)LZPlace of Disposition ZiUe,j Crovcfdr)v..
MI (address)
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fY
(section) _`(l o�t number) (grave number)
p l Name of Sexton or Per on in Charg of Premises nir�' G� .S�p�(�
Z (please print)
w i
Signature 1.�.. Title f at
(over)
DOH-1555(02/2004)