Hafner, Bessie NEW YORK STATE DEPARTMENT OF HEALTH ii L ')
Vital Records Section r ,'i► Burial - Transit Permit
Name First Middle Last Sex
Bessie May Hafner Male
Date of Death Age If Veteran of U.S. Armed Forces,
January 19, 2012 87 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Argyle Street Address Pleasant Valley Infirmary
til. , Manner of Death I I Natural Cause Accident Homicide Suicide Undetermined Pending
ILI Circumstances Investigation
CI
u! Medical Certifier Name Title
:0
Address
;i°'j Death Certificate Filed District Number Register Number
City, Town or Village Argyle ! 5-73 D . 7
❑Burial Date Cemetery or Crematory
January 21, 2012 Pine View Crematory
❑Entombment Address
EX Cremation Quaker Road
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
N
0 Date Point of
NTransportation Shipment
p 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 01443
Address
53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
$' Remains are Shipped, If Other than Above
g Address
Us
gi
Permission is hereby granted to dispose of the human rem ins described bove as indicated.
:1
Date Issued I/c9U 1 f.- Registrar of Vital Statistics ilti
signature)
District Number rl Place Argyle
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z W Date of Disposition (/7 4/I L Place of Disposition c)",,v 401 Crowd or,,)*.
2 (address)
W
U)
CL (section) /�j , (lot numbp) (grave number)
p Name of Sexton or Person in Charge o Premises `'/r r,s!A 0 r J tn,v
Z (please print)
W Signature /14 _ Title aCv+1p1T t)(L.,
(over)
DOH-1555(02/2004)