Delmonaco, Lois 12/24/2013 09:51 5183773446 LIGHTS FUNERAL HOME tt - 1t PAGE 01/01
t -_ 1
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section , . . . _ rok
` Name First * Middle Last •Sex •
LOIS DELMONACO FEMALE
. Date of Death Age , 1f Veteran of U.S.Armed Forces,
12/20/2013 86 War or Dates
i[y; Place of Death Hospital,Institution
City,Town or Village City of Albany or Street Address ST. PETER'S HOSPITAL
1111-} Manner of Death Natural ❑ Accident 0 Homicide 0 .Suicide ❑ Undetermined ❑ Pending
, f Cause Circumstances investigation
Medical Certifier Name Title
+17t PARVEZJAFRI M.D.
Address •
815 S. MANNING BLVD ALBANY, NY 12208'
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 a 2434
Date Cemetery or Crematory
ir CI Burial 12/24/2013 PINE ViEW CREMATORY
;;:, 0 Entombment Address
''' ®Cremation QUEENSBURY, NY
Date Place Removed
Z Removal and/or Held
42 ❑ and/or Address
N. Hold
fn
p Transportation Date Point of
•
N. ❑ By Common Shipment �.____
a` Carrier Destination
i.; ❑ Disinterment
Date Cemetery Address
-
Date Cemetery Address
D Rsnterment
Permit Issued ToReg —
Name of Funeral Home REGAN DENNY STAFFORD FUNER HOME 01443 tion Number
AIL
Address '�
ifi 53 QUAKER AVE. QUEENSBURY, NY 12804
,; Name of Funeral Firm Making Disposition or to Whom
e` Remains are Shipped, If Other than Above
2. AddIX: ress
I
IX Permission is hereby granted to dispose of the human remains describe above as indicated.
i!ii; Data 12/24/2013 `
i„ Issued Registrar of Vital Statistics �
(si ature)
District Number 101 . Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of In accordance with this permit on:
.•Dale of Disposition is/30113 Place of Disposition I
kV .Le i(11..._
-14
ii (address)
vy
(section) (lo umber) —(grave number)
, Name of Sexton or Person in Charge of Premises r,,rt HN
//d I,— (please print)
' ;, Signature •
Title ,e y
(over)
DOH-1555 (02/2004) iI
I