Lee, Denise Y / G--
& . N
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Denise C Lee Female
Date of Death Age If Veteran of U.S. Armed Forces,
November 16,2013 71 War or Dates
Place of Death Hospital, Institution or
2 City,Town or Village Glens Falls Street Address Glens Falls Hospital
or Manner of Death a Natural Cause Accident E]Homicide Suicide Undetermined Pending
f!U Circumstances Investigation
t9 Medical Certifier Name Title
Scott Biasetti MD
Address
100 Park St,Glens Falls,NY 12801
Death Certificate Filed District Number Registeriy�nbpr
City, Town or Village Glens Falls 5601 � (72
❑Burial Date Cemetery or Crematory
November 18,2013 Pine View Crematory
D Entombment Address
®Cremation Quaker Road,Queensbury,NY 12804
Date Place Removed
2C El Removal and/or Held
and/or Address
F
Hold
O Date Point of
N El Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
ID
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
Remains are Shipped, If Other than Above
Address
Ili
O. Permission is h re y granted to dispose of the human rains scribed a ove as indi ted.
Date Issued O Registrar of Vital Statistics /7P p-.I7 ,
(signature)
District Number son Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in)accordance with this permit on:
W2 Date of Disposition II %toIt3 Place of Disposition i,rtedi(d (rier 4ot .
LU
(address)
IZ
(section) (lot number (grave number)
p Name of Sexton or Person in Charge of Premises di iit c 0116-46
W 4L.
(please pint)
SignatureTitle Clllrh►iiT0P
(over)
DOH-1555(02/2004)