Gotti, Margaret NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
<: Name First Middle Last Sex
Margaret Gotta male
Date of Death Age If Veteran of U.S. Armed Forces,
05/13/1999 88 War or Dates n/a
Place of Death Hospital, Institution or
UX Town)OXXVOP Queensbury Street Address Hallamrk Nursing Centre
Manner of Death Natural Cause Accident Homicide Suicide E]Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
S. R. Spitzer, MD
Address
55 Sheridan Street, Glens Falls, NY
Death Certificate Filed District Number Re ister Number
(ZX% Town OXYIA)w Queensbur 5657
Date Cemetery or Crematory
❑Burial 05/14/1999 Pine View Crematory
Address
®Cremation Quaker Road,' Queensbur NY 12804
Date Place Removed
Z ❑Removal and/or Held
and/or Address
}' Hold
Efj -
Q Date Point of
Q Transportation _ Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Ej Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Funeral Home 01565
Address
53 Quaker Road, Queensbury, NY
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 ( remains described above as indicated.
Date IssuecE� Registrar of Vital Statistics ` G/' C)CAJ
(signature)
cc Place
District Number��Qs
I certify that the remains of the decedent identified above were disposed of in accordance vkth is permit on:
Z Date of Disposition Place of Disposition
(address)
W
(section) (lot number) (grave number)
AName of Sexton or Person in Charge of Premises
g (please print)
Signature Title
DOH-1555 (10/89) p. 1 of 2 VS-61