Streeter, Edna M NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Biostatistics -Vital Records Section
«: Name First Middle Last Sex
> ' Edna M. Streeter Female
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:> Date of Death Age _ If Veteran of U.S.Armed Forces
War or DatesNo
:........................Jame 27, 1988 > :......::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::.:...:::.:::::::::::::
:. ........................::..........,,.....................
,,�, Place of Death ': Hospital, Institution or
City,Town or Village Glens Falls New York Street Address 7 Madison Street
Causeof Death:::::....................................-111.....-... ........."....................................................................................................................................................................
:.:::..
Cardiac Ventricular Ca;;.: . a :::::::.... ::::::::::::::
Medical Certifier Name Title
Richard T. Hogan M.D. ......::......::......::::::::.......
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Address
<'< 325 Main Street Hudson Falls, New York 12839
..... inter Number::::::..................
Death Certificate Filed District Number Reg
's City,Town or Village Glens Falls New York 5601 J 6
Date Cemetery or Crematory
El Burial June 30 1988
,.::::::::::::::::::::::::::.:::::::::::::::::: > Pine„View„Cremato?�'......:::::::::::::::......:::::::::::::::::::::::::::::::::::::::::::::::......
®Cremation Address
Quaker Road Queensby, New„York.
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:Z Date Place Removed
Q; Removal and/or Held
and/or Hold ::::::::::::::::::::.:::......::......::::::::::......:::::::::::::::::::::::::......:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::.::::::::::::::::::::. ......::......::::::......::::.......
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'' Address
tn.
Q............:::::::::::::::.... :::::::::::::::::::::::::::::::::::::::::::::::::::::::::.::::::::::,::::::::::::::::::::::::::::..::::::::::::::: ::::::::::::::::::::,::.:::::.:.
Date : Point of
(n: []Transportation by Shipment
Common Carri
er ..........................................................................................................................
Destination
......................................... ..........................................................:::<:::Ca mete Address::::::...................................................................................................
771
Disinterment Date Cemetery
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Reinterment Date : Cemetery Address
Permit Issued to Registration Number
[ <`: Name of Funeral Firm.......James..F'....SingletonInc.....................:....::::::::::::::::::::::::::::::::::::::::::::::::::::::::::.:.:.:::.:.:::::::.::::.:Q22$�.::::::::::::::::::::.:......::::::
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Address
314 Bay Road—P.0. Box 681 Glens Falls, New York 12801
Disposition or to Whom
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Name of Funeral Firm Making
Remains are Shipped, 9 Other than Above
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Address
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Permission is hereby granted to dispose of the human mlins scrlb above as indicated.
Date Issued Jane 28, 1988 Registrar of Vital Statistics 4-
nature)
?< District Number 5601 Place Glens Falls New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W` Date of Disposition 0 —'Place of Disposition
(address)
UjLL
N` (section) (lot number) (grave number)
pName of Sexton or erson in rge of Premi s
W' , ase print)
�
Signature Title
DOH-1555(9/86)p 1 of 2(formerly VS-61)