Manion, Lillian V -73b
NEW YORK STATE DEPARTMENT OF HEALTH - -
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Lillian Regina Manion Female
Date of Death Age If Veteran of U.S. Armed Forces,
December 4, 2013 95 War or Dates
f,,j Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address Stanton Nursing& Rehab Centre
1 Manner of DeathUndetermined Pending
0 Natural Cause E Accident n Homicide n Suicide n n
Circumstances Investigation
Medical Certifier Name Title
D Patricia Auer,PA
Address
Queensbury,NY
Death Certificate Filed District Number Rpg�err Number
City, Town or Village Queensbury,NY 5657
❑Burial Date Cemetery or Crematory
December 5, 2013 Pine View Crematorium
❑Entombment Address
El Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
ZZ fl Removal and/or Held
and/or Address
H Hold
co
O Date Point of
N ❑Transportation Shipment
p by Common Destination
Carrier
El Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit 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
�'1/1 Remains are Shipped, If Other than Above
Address
,L Permission is hereby granted to dispose of the huma r ains described boy as indicated.
Date Issued I�/C 10-C Registrar of Vital Statistics . Ca� A '
(signature)
District Number 5657 Place Queensbury,NY
I certify that the remains of the decedent identified above were disposed of ininn accordance with this permit on:
w Date of Disposition I -(,•-p'3 Place of Disposition Uk,..Y C.,,,404.w)--\
(address)
W
CO
re (section) (lot umber) (' (grave number)
00 Name of Sexton or Person in harge of Pre 'ses / t-(i.s r 3 coveil
Z ease print)
w
Signature -T Title ongitt
(over)
DOH-1555(02/2004)