Bain, Lillian NEW YORK STATE DEPARTMENT OFHEALTH ���8�~��N ~ ����U����~� D����8��^�
����� ���~ Transit Permit
Vital Records Section
Name First
Middle Last Sex
Lillian Bain Female
Date of Death Age
....... If Veteran of U.S. Armed Forces,
..4� Place of Death Hospital, Institution or
:.U11 i y,Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death
a Natural Cause E3Accident Homicide El Suicide Ei Undetermined o Pending
...... Circumstances Investigation
Medical Certifier Name Title
:Q Paul F. Bachmann MD Coroner
Address
Warrensburg, NY 12885
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601
Date Cemetery or Crematory
Churial Nov. 22, 1991 Pine View Crematorium
Address
z Place Removed
0 Removal and/or Held
Date Point of
]Transportation by:
Destination
:: Date Cemetery Address
Disinterment
Date Cemetery Address
El Reinterment
Permit Issued to
Registration Number
Firm Flynn Bros. Inc. 00667
Name of Funeral
Address
Name of Funeral Firm Making Disposition or to Whom
:21 R emains are Shipped, If Other than Above
Address
jman�lrins described b s indicated
........ Permission is hereby granted to dispose of the hi
-22-91
Date issued 11 Registrar of Vital Statistics
District Number L:�� Place
|certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date ofDisposition Place ofDisposition
(address)
LU
Cn (section) (lot number) (grave number)
cc
0 Name of Sexton or Person in Charge of P emises 'c'-2kwep A!�zdrz��? z
o: (please print)
m
Signature '4�m —
Th|
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