Christman, Lelia NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Lelia E. Christman female
Date of Death Age If Veteran of U.S. Armed Forces,
July 14, 1998 77 War or Dates
Place of Death Hospital, Institution or
City, Glens Falls Street Address Glens Falls Hospital
Manner of Death 0 Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined El Pending
A. Circumstances Investigation
Medical Certifier Name Title
David Schwenker, MD
Address
90 South Street, Glens Falls- NY
Death Certificate Filed District Number Register Number
City, 7�amydEM7GC K Glens Falls 5601 t�
Date Cemetery or Crematory
❑Burial July 16, 1998 Pine ViewCrematory
®Cremation AddressQuaker Road, Queensbury, NY 12804
Date Place Removed
o❑Removal and/or Held
••• and/or Address
Hold
Q Date Point of
N❑Transportation Shipment
by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan and DennyFuneral Home 01565
Address
53 Quaker Road, Queensbur , 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 remains described above as indicated.
XX
Date Issued '7 h 6 ci-3� Registrar of Vital Statistics �� Y� c,t - A C®c v, n �.w ,,•>
(signature)
District Number $ ,0 I Place
I certify that the remains of the ecedent identified above were disposed of d�in accordance with this permit on:
WDate of Disposition Place of Disposition/ /r���
(address)
W
M (section) (lot umber) / (grave number)
GName of Sexto or Person Charge of P mises ����� J
g (please print)
Signature Title
DOH-1555 (10/89) p. 1 of 2 VS-61