Hogan, Anne NEW YORK STATE DEPARTMENT OF HEALTH g 3
Vital Records Section , . Ni Burial - Transit Permit
€<- Name First Middle Last Sex
Anne C. Hogan Female
< Date of Death Age If Veteran of U.S. Armed Forces,
May 17, 2015 94 War or Dates n/a
Place of Death Hospital, Institution or
City, Town or Village Wilton,NY Street Address 106 Traver Road
Manner of Death I)(I Natural Cause ❑Accident n Homicide Suicide Undetermined Pending
, Circumstances Investigation
1t.
Medical Certifier Name Title
Dr.Anthony Petracca,MD
,fr Address
',1 Glens Falls,NY
;'"" Death Certificate Filed District Number Register Num er
' 'a City, Town or Village Wilton,NY 4569
ar-
❑Burial Date Cemetery or Crematory
May 19,2015 Pine View Crematorium
❑Entombment Address
❑x Cremation 21 Quaker Road, Queensbury, NY 12804
Date Place Removed
Z — Removal and/or Held
O —and/or Address
H Hold
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O Date Point of
Nn Transportation Shipment
as by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
',',.-.1 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
iRemains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as inlicated.
Date Issued `�/���/�} Registrar of Vital Statistics
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District Number __ "� Place '_'_"
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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W Date of Disposition s7z�'!5` Place of Disposition ,,N,�
(address)
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re (section) _(lot number) (grave number)
pName of Sexton or Person in Char e of Premises 4.1, Simo
Z / (please print)
usSignature �i► Title ( voJic
(over)
DOH-1555(02/2004)