Hilder, Jennifer NEW YORK STATE DEPARTMENT OF HEALTPI . 6,
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Jennifer Hilder Female
Date of Death Age If Veteran of U.S. Armed Forces,
November 11, 2013 40 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Moreau Street Address 260 White Birch Estates
O Manner of Death ❑Natural Cause ❑Accident n Homicide n Suicide n Undetermined 1-1Pending
Circumstances Investigation
WMedical Certifier Name Title
O Susan Hayes-Masa
Address
579 Grand Ave,Saratoga Springs,NY 12866
Death Certificate Filed District Number Register Number
City, Town or Village Moreau 4562
❑Burial Date Cemetery or Crematory
❑Entombment Address
❑Cremation
Date Place Removed
Z ElRemoval and/or Held
• and/or Address
F_ Hold
N
O Date Point of
51") ❑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
94 Saratoga Avenue, South Glens Falls, NY 12803
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped, If Other than Above
2 Address
• Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued ///i3/ oiJ Registrar of Vital Statistics
(signature)
District Number 4562 Place Moreau
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
) der..4,047,7
W Date of Disposition ///9-73 Place of Disposition Ave- ice/
(address)
(section) nu/Fiber) (grave number)
pName of Sexton r Pers i harge of Premises �j eat
//f7v7G�.
Z (please print)
W Signature _ /OM U- Title 07(11491r47-2 f>5�
(over)
DOH-1555(02/2004)