Zurita, Libio 51
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
I Name First Middle Last Sex
Libio Leon Zurita male
Date of Death Age If Veteran of U.S. Armed Forces,
12/03/1999 52 War or Dates n/a
Place of Death Hospital, Institution or
City, T6vmYot-x\AV.,q c Glens Falls Street Address 206 Maple St. , Apt. C
Manner of Death❑Natural Cause ❑Accident ❑Homicide Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Christopher D. Hoy, MD
Address
102 Park St. , Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, Tt4vVt4ix Glens Falls 5601
Date Cemetery or Crematory
❑Burial 12/06/1999 Pine View Crematory
®Cremation AddressQuaker Road, Queensbury,NY 12804
Date ----7Place Removed
8 ❑Removal and/or Held
and/or Address
Hold
Q Date Point of
N ❑Transportation Shipment
by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Funeral Home 01594
Address
53 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is here y ranted to dispose of the human remains described above as' is ted.
Date Issued (o Registrar of Vital Statistics �-
(signature)
District Number S�(o0/ Place
certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
z Date of Disposition t�- - Place of Disposition ]� ` lY r d t,J (,) �� 0 RIO�
(address)
N
>l (section) (lot number) (grave number)
OName of Sexton or Person in Charge of Premises �p (A (z!j �fZAll��
g (please print)
Wii Signature Title CLA
DOH-1555 (10/89) p. 1 of 2 VS-61