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Wright, Pearl NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Vital Records Section Name First Middle Last Sex _.......::.P .x.J.:::.E:.......Wr i.g. h.t:................... ,F em a l e Date of Death Age If Veteran of U.S.Armed Forces, 10/9/9 3 9 0 War or Dates Nc F- . .. .................: ......... ......... ......... .... .... Place of Death Hospital Institution or WCity Town or Village Town of Argyle Street Address Pleasant Valley Infirmary 14 Manner of Death f Natural Cause Accident Homicide Suicide Undetermined a Pending LL�� Circumstances Investigation ................ .... ......... ............ . .::::: ..... .. ......... . ....... ....... ............ . :....::.. Medical Certifier Name Title 4 Dr. Patricia Hale ......................:......::..::::.:.....:.: ..:.:::::.............................:..................................... ..........: .............................. Address 7.2.40 Ume.r Broadway Fort Edward.,...NY...... 12828 . .....::: ..: ......... Death Certificate Filed District Number Register Number City,Town or Village Town of Argyle 5750 32 Date Cemetery or Crematory El Burial 10/11/93 PineView Crematorium :..................... ...................:.................:...: .... ... . : .... .: ...... ........................ ......... ....... . . ......... ............... ©Cremation : Address Town of Queensbury, NY .. . _..... ......:::: ..... :... ...:..:: .. ........ Z...... Date Place Removed 0, ❑ Removal and/or Held F- and/or Hold Address .................,::...:...... N 0......... ...:...:. ...:.:::................. ....... ::.::. ...... ... _.. a Date Point of N []Transportation by:: Shipment p Common Carrier ............... ...........:.::::........ .....: . Destination .................................... .................................... ..:. .. :::::.... . ❑ Disinterment Date Cemetery Address .......:: ... ... ....................... ..- ...:: . ....:. ....... ......... ......... ......... ............. ...... ............. ❑ Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Firm Masan Funeral Home 01221 _.:............. . ... ............................. Address P.O. Box 2.7.7. Fort. Ann.,.... NY 12827 ............... ................::.................................................. . . .. ..... ::: ....... _ .... ._.... _.... !-: Name of Funeral Firm Making Disposition or to Whom Z. Remains are Shipped, If Other than Above ....... ........................................................................ ......... . ........... : - Address i _ _ Permission is hereby granted to dispose of the hum remains de ribed above as Indicated. Date Issued 10/10/9 3 Registrar of Vital Statistics , (signature) 5750 Main Street Argyle, NY 12809 District Number Place certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F- Z' Date of Disposition IC.*,-/3-9Z Place of Disposition pi It/ e- U I fy GCa G r ,fY1 o-Tr_1_(i�YL (address) W Cn (section) (lot number) (grave number) cc 0, p; Name of Sexton or Person in Charge of Premises Pa c, - ko pe �- Z (please print) _ W Signature Title L r-e_, M CL I r (Lfi3 i4SS IT DOH-1555 (10/89) p. 1 of 2 VS-61