Glander, Mabel NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section Sex
Middle Last
Name First Glander female
Mabel
Date of Death Age If Veteran of U.S. Armed Forces,
12/15/1998
92 War or Dates no
Place of Death Hospital, Institution or
i , Town �rK KI X Queensbury Street Address Westmount Health FacPend
Undetermined Pending
Manner of Death 0 Natural Cause Accident Homicide Suicide Circumstances Investigation
Title
Medical Certifier Name
S. ich Lr
ze-
Address
55 h Register Number
<: District Number
Death Certificate Filed
XQi Town fQy, 'Rtk)@X Que Cemetery or Crematory
Date
❑Burial 12 17 199
FX Cremation Address Quaker Road, Queensbury, NY 12804
Date Place Removed
2❑Removal and/or Held
and/or Address
Hold
Point of
Date
Q Shipment
NQ Transportation
by Common Destination
Carrier Cemetery Address
Disinterment
Date
Date
Reinterment Cemetery Address
Registration Number
Permit Issued to
Name of Funeral Home Sullivan-Minahan & Potter Funeral Hdme
Address
407 Bat Road Queensbury, NY 12804
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 human ains desLJA
b e as indicated.
all
Date Issued - �p-� Registrar of Vital Statisti s (signat
Plac
District Number permit on:
t certify that the remains of the decedent identified above wer d posed of in accordance ith th p )
f- f Dis osition r 42 r/v
Date of Disposition Place o p
(address)
tWtJ (section) (lot number) l (grave number)
C Name of Sexto or Person in Charge of Premises )FT; /�
(please print) ,
z — Title
Signature -' '
(over)
DOH-1 s5s (9/98)