Liburdi, Harper NEW YORK STATE DEPARTMENT OF HEALTH 0"*. 461,3
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Harper Mane Liburdi Female
Date of Death Age If Veteran of U.S. Armed Forces,
8/12/2018 0 War or Dates
• Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death Natural Cause n Accident n Homicide U Suicide n Undetermined n Pending
Circumstances Investigation
,Medical Certifier Name Title
• Syed Kamal,MD
Address
100 Park Street,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number !
City, Town or Village G(3) 3�`
❑Burial Date Cemetery or Crematory
Entombment August 15, 2018 Pine View Crematory
Address
®Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z
n Removal and/or Held
and/or Address
Hold
CO
O Date Point of
W Transportation Shipment
p by Common Destination
Carrier
C Disinterment Date Cemetery Address
n Renterment 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
i_-; Remains are Shipped, If Other than Above
2 Address
CC
Permission is hereby granted to dispose of the hum4remains described above as in• •.
Date Issued 0 / Registrar of Vital Statistics 7 7 o� y727 �f2.'--rf-'
. ,Q ��L �1 (signatu
�� < .
District Number � / Place �1� �`,
I certify that the remains of the decedent identified above w e disposed of in accor\715 nce with this permit on:
w Date of Disposition - 1 c Place of Disposition .OyitQ.�� w Ct .fro y
W i (address)
U)
(section) (lot number) (grave number)
pName of Sexton or Person in Charge of Premises J ct.,,,.�,y Saijr�-c
Z (please print)
W Signature Title Cfcm; a6"
(over)
DOH-1555(02/2004)