Leary, Kathryn Air ii
12/28/2013 12:55 15184895E32 TEBBUTT FREDERICK PAGE 01 NEW YORK STATE DEPARTMENT OF HEALTH 4V-7 �o1 ..
Vital Records Section
Burial - Transit Permit
Name First ,mememmmilmom„...„,....mmiiiiimmi.m.i.....
Kathryn Middle Last
Date of Death I — A. Lea Sex
December 26,2013 �1 Age If Veteran of U.S. Armed Ford es; Female
Place of Death S0 War or Dates_
• City, Town or Village Albany Hospital, Institution or _
Manner of Death n —� Street Address Albany Medical Center
• Natural Cause ❑Accident _Homicide
Suicide Undetermined Pending
Medical Certifier Name — — - Circumstances —Investigation
PA
Title -`-`
• Address - --Death Certificate Filed ,.— —y District Number
City, Town or Village Albany 101 1 register Number
0 Burial Date Cemetery or Crematory "
_December 30,2013 Pine View Crematory
Entombment December
®Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
z E Removal
9 and/or Address —..—.—._, and/or Held -
Hold
c - Date Point of ' '—.—
_Transportation , 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 01444
Address W
94 Saratoga Avenue, South Glens Falls, NY 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
' Permission is hereby granted to dispose of the human ains d scri d boy indicated.
Date Issued 12/28/2013 'Registrar of Vital Statistics
signature)
District Number 101 Place Albany .
I certify that the remains of the decedent identified above were disposed of in accordance with
this permit on:
E Date of Disposition I/b 113 Place of Disposition 4is Vew/ L 4t'--
ME
(address)
W
co - -
(section) ( numbs (grave number)
Name of Sexton or Perso in Charge of Premises Ai
tnrrtiiO ( ease print)
W signature - Title P______.____,_lk a
Signs
(over)
DOH-1555 (02/2004)