Bryman, Anne G NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Anne Gertrude Bryman Female
- :: ....
Date of Death Age If Veteran of U.S.Armed Forces,
March 10, 1991 61 War or Dates No
....... _:: ..... ..:-.. ,: :.... .:-......... ...............
. Place of Death Hospital, Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death n Natural Cause Accident Homicide Suicide Undetermined Pending
UU Circumstances Investigation
U .....:: ...........::.:....... ........-_ _ .:... ...
�. Medical Certifier Name Title
p Dr. Surendra K. Nevatia
............................................ .... .... ....... ..............ddress
92 Broad Street Glens Falls, New York 12801
..............::. .- .. .:: .. --........:::
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls f1�1
Date Cemetery or Crematory
❑Burial March 14, 1991 Pine View Crematory, Queensbury, New York
::... _...............................
El Cremation Address
:..Queensb:ury:,.:.:New...York.
mov
Z Date PlaceRemoved
O", ❑ Removal and/or Held
F- and/or Hold :::.:::. .......Add
Fn
0..................... ......... .:.... ..:: :.... .........
a Date Point of
Ni []Transportation by: Shipment
p Common Carrier ... .:........ ......... _
.........................
Destination
.........
❑ Disinterment
Date Cemetery Address
❑ Reinterment Date CemeteryAddress
Permit Issued to Registration Number
Name of Funeral Firm Regan &„Denny _Funeral Home 01634_
...... ..
Address
26 Quaker Road, Queensbury, New York 12804
.._ ..._ ......... .:..............:...:.......... ....... .. _ _...: ...........
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
tr::. ...::..................................................... .....::. . .
Address
.41
..
Permission is hereby granted to dispose of the human rem s described above as indicated.
Date Issued Registrar of Vital Statistics
nature)
District Number V� Place
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition Place of Disposition �%/V�
2 (address)
LU
N (section) (lot number) (grave number)
0' .��t�i9�r'D 1W f'9 p Name of Sexton o Person in C arge of Premises
ZI (please print) i
W Signature-6rG Title / �/
DOH-1555 (10/89) p. 1 of 2 VS-61