Wright, Kathryn G NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
...... Female
K th
a ...... .................................r,.i ght........................................................ ......................................................... ............................................................ ... .............................
Date of Death Age If Veteran of U.S.Armed Forces,
Feb 6, 1992 62 War or Dates No
..................................................-...................................-....................---.............................................. .......................................... ..........................................
Place of Death Hospital, Institution or
U. City,Town or Village Glens Falls Street Address Glens Falls Hospital
........ ... ........ ..........-...
.................. ...............................-................................... .................---.................................................................................
Manner of Death Natural Cause Accident D Homicide El Suicide o Undetermined o Pending
YEVN El
...... Circumstances Investigation
. ........ ....... .. ................................. ..................... ................... ...........
Lu
Medical Certif ier Name Title
M
Mark Hof mn,....-ND ....... ................... ................................. ...... .......................................
Address
...... 84 d...... ...Broa n Falls......NY...1.280.1....... ........... ................ . .... . ....................
le. ..s
.............................................. ................................................
Death Certificate Filed District Number Register Number
City,Town or Village Glens Fa 11 q 5601
Date Cemetery or Crematory
E]Burial
Feb..7 199,2 ..... c tor,
ew ................................................. .................................................. .......... .............. .................Plim�..:V.............X ..T.
Er
Address Cremation
ker Rd 12804 ................................ ...Queensburv, NY. ....... ............. .....................................................
........... ........Quaker:..
..........................''............. .......................................................1............ ......
z Date Place Removed
2 E] Removal and/or Held
and/or Hold Add-r-es-s............ ......................................................................................... ............. ......................................................
Fn
0.... .................... .................... ........... .. ... .... ...................
Date Point of
Ln E]Transportation by
Shipment
0 Common Carrier ................... ................ ..................................................................................... ........................
Destination
...................................
.......................................................................................................................... ............................................ ........................................
Date Cemetery Address
El Disinterment
........... ...... ..............
....................................-......................................................................................................................
.............................-......................................................
❑
Date Cemetery Address
Reinterment
Permit Issued to
Registration Number
James F. Sinaleton, Inc.
Name of Funeral Firm
...M25-......................... .........
................... .............................................. .....Singleton, ...................... ............
Address
314
........ . ....... . ... Bay. Rd. Queensbur NY.... 2804.
...... .................................... ... .................................................................
..........
44 Name of Funeral Firm Making Disposition or to Whom
2: Remains are Shipped, If Other than Above
....... ................................ ................................................... ............................... ..
...............................................................................
':.::Address
Address
.............................................................................................................................................................................................. ............................................... ..............
Permission is hereby granted to dispose of the h4Man remains d scribed above as indicated.
Date Issued Feb 7, 1992 Registrar of Vital Statistics C�t'a L
(signature)
District Number 5601 Place Glens Falls, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
7 ?
Z Date of Disposition C;7- Place of Disposition 4-1W"e
W
2 (address)
LLJ
W (section) (lot number) (grave number)
cc
0
a Name of Sexton or in C arge of remise 450 IV 10
z lease print)
LU Signature Title
.................-............ ...........-................-.1.11............... I--..................................................-....... ........................... ..............................
DOH-1555 (10/89) p. 1 of 2 VS-61