VanBuren Sr, Dennis NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Biostatistics -Vital Records Section
Name First Middle Last Sex
Dennis James Van Buren Sr. Male
....Date of Death::::............................................... ..................................................
....:::::.::::.:::._....._:::::::::.:_::::::::..:...::::::::::............._....................._.._._;............................. _.
Age If Veteran of U.S.Armed Forces,
War or Dates
.<:>::::::::::::::::.:...... rY. 8.�. 1.9.91....... 39 No
Place of Death :,::.Hosp'ital;_:Institution:.o :::::::::.::::::::::.:::::::::::::::::::::::::::::::::::::::::::::.::::::::::
City,Towm-oarVillala Glens Falls Street Address Glens Falls Hospital
.........
:::..:.
:> Cause of Death
::t3i1
MultilUstem Fa. .
lure:::.:::.:::::.......:..._._........................_._.................................._...._......._.__..................._.........._.............................
.. .............................................................................................................................................
Medical Certifier Name Title
............:::Jos:e.ph::::C.:.:::::Mihindukul_asur.i .a......................... M.D...........................
:.;:.;::. ......... .............. .—s.::::...:.::..:........:::::.:.:......::.:::.....Y.:::.........................::::::::::::::::..:.........................::::::::::.
Address
.....__.........52....Park....Street.,....Gle.ns....Falls-,. N.Y.Y...._.....1.280.1.............................._......._..__....._........_............._...._.....
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Death Certificate Filed District Number ; Register Number
City,Tawaeau;NaSee Glens Falls 5601
Date Cemetery or Crematory
❑Burial March....1..,....19.9.1..........................>..............P.ine....Vi.ew.._Cremator .................................
Y
®Cremation Address
u.e.en.s bu r.... .....N....Y...,.........1.2.8.0.4..........................................................................................................
:.........:..:......:::::'..:::::::::.:::::::.:::::::.................Q.............:................y........:.........................:...... ..::............................................................................................................
Z ': Date Place Removed
Oi0 Removal and/or Held
and/or Hold :::::.::::::::::::::::::::::.::.:::::::::::::::::::::::::.::::::::::::::::::::::::.:>:......:::::::::.:::._:.:::::::::::::::::::::::::,::::::::::::::.::::::::::::::::::::::::::::::::.:::::......::::.......... ::::::::,:,::::::::
Address
>ll
Date _ Point of
fA Transportation by Shipment
Carrier .........................................................................................................................................:.........:............................................
Common
q:: ::::::::::::::::.._..........................................;........................................................................................................._...._........._...................
Destination
;:;:.::: :::::::::::..........................................................::.:::. ::::::.................................................................. . ............. .....................................: Date Cemetery Address
Disinterment ...........
....................................... .......................................... meteAddress':::::...................................................................................................
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Reinterment ` Date Cemetery
Permit Issued to ' Registration Number
Name of Funeral Firm Michael G. Angiolillo Funeral Home 00045
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........... .......... ....
ress::::::................................................................................................................................................................................. ........ ........ ... .........
210 Broadway, Whitehall , N.Y. 12887
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Name of Funeral Firm Making Disposition or to Whom::::::..................................................................................................... ......................................
9
Remains are Shipped, Above ed, If Other than Ab
Address
:: :....._..................................._....... _.... ................. .....................................................
Permission Is hereby granted to dispose of the hu n r main , describe . above ads Indicated.
Date Issued 3/1/91 Registrar of Vital Statist' ✓
(signature)
District Number 5601 Place City of Glens Falls, N.Y.
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition Place of Disposition
(address)
w
>OC
(section) (lot number (grave number)
Name of Sexton r Person i Charge of Pr raises
9 (lase Pact) �i/�,c�/�/�/Q i l'
Si nature Title
DOH-1555(9/86)p 1 of 2(formerly VS-61)