Tansey, Freda NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Freda Tansev Female
..................- ........Freda .......................................... ........................................................
Date of Death Age If Veteran of U.S.Armed Forces,
War or Dates 81 3-15-91
. ........................ ........................ ................................................. ..............................................................
14� Place of Death Hospital, Institution or
Street Address
..LU City,Town or Village s
................................................. ...N-H..... ....................................................
. ................................. ....G.lens...Falls...................... ..............Eden...Park
Manner of Death o Undetermined Pending
W, Natural Cause Accident El Homicide El Suicide
........ Circumstances Investigation
. ........ ... ...............................
Xu.................................................................... ..................... .... ............................................
Medical Certifier Name Title
:0
..............................................William...Tedeszo................................ .....MD........................................................................................................... ..................
Address
17 Pine St. Glens Falls NY
.......................... ...........................---......... ............................................................................ .................. .......
Death Certificate Filed District Number Register Number
City,Town or Village 3-18-91
Date Cemetery or Crematory
ElBurial
............. ......Pin.e...View...Crematory........................................................................................
Cremation Address
.......................... '' ........ ..........Quessbury......NY... . ......... ...................................
z bate Place ........................................................
Removed
2 [] Removal and/or Held
and/or Hold A d d'r'e's'...s ...................................... .............. .............. ......
Fn
0...................... ................................................................................... ................ ................................................
Date Point of
a) E]Transportation by: Shipment
a
CommonCarrier ....................... ....... .......---.............................................................
Destination
....................... .......................................me...... .......................... ...........................................
Date Cetery Address
❑ Disinterment
......................I.I.I...,..............,.,.,.�.I.I.�.�.....,..,..I................................. .............. ...................... ........................................................................................
El Reinterment ...... .........
Date Cemetery Address
......
Permit Issued to
Registration Number
Name of Funeral Fir
.. e.gan
m R ...&Danny....Funeral Service.....Inc ........
.......Address
.................. ......
Address
................ ...Rd... Quopnsbury.......NY...12.8.04....................................................... ........................................ ...................
................ ...............................
Name of Funeral Firm Making Disposition or to Whom
2. Remains are Shipped, If Other than Above
.
..................................................................... ...................
. ......... .................... ........................................................... .................
.M.,
'V Address
......................................................................... .................. ..................................................................... ...... .........
Permission is hereby granted to dispose of the hu7(,an remain es ed above as indicated.
Date Issued Registrar of Vital Statistics
(signature)
District Number Place
I certify that the remains of the decedent identified above were disposed of in accordanc with this permit on:
/Place of Disposition zj6c CZ:e?��V
�Z Date of Disposition 3 ition 6,
(address)
(section) (lot number) (grave number)
it
a Name of Sexton or erson in rge of Premise
z print)
Uj Signature
Title 7r
.. ........ ............................................................................................................................ ...... ...........................
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DOH-1555 (10/89) p. 1 of 2 VS-61