Whible, Augustus NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Augustus Whible Sr. male
Date of Death Age If Veteran of U.S. Armed Forces,
01/24/1999 96 War or Dates no
Place of Death Hospital, Institution or
City,XUro`WSKUMM Glens Falls Street Address Glens Falls Hos tial
Manner of Death Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
C.
James North, MD
Address
Health Center @ Northcare, Glens Falls, NY 12801
Death Certificate Filed District Number Register tuber
City,XprdW�d(�4i(i XM6 Glens Falls 5601
Date Cemetery or Crematory
❑Burial 01/27/1999 Pine View Crematory
Address
F Cremation Quaker Road, Queensburry,, NY 12803
Date Place Removed
Z Removal and/or Held
and/or Address
Hold
0 Date Point of
N ❑Transportation Shipment
0 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 01565
Address
53 Quaker Rod, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the huma;Js
ins described Hove as ind' ted.
Date Issued `o(0-�}9 Registrar of Vital Statistics
nature) _
District Number �6
Place �i 1` S4-
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
f- �1 c�
W Date of Disposition c�—J`/ Place of Disposition /0//yam f���,� �' �j, /� /t fJh?
2 (address)
W
N
cc (section) (lo n ber (grave number)
GName of Sexto or Person in Charge of PremisesjJf��� /
z lease print)
Signature Title Qf
(over)
DOH-1555 (9/98)