Abraham, Margaret NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
..:........ arg.aret..... E...... ......... .Ab.raha_ .m. ......:.: ::. :. .. ............. female,.::,: .
Date of Death Age If Veteran of U.S.Armed Forces,
J.a.nuary., 21. 1994 War or Dates ............ . ..........
,..................... ..... .: 7� :.:::..: ....n.o.:...::. : . :...
Z Place of Death Hospital, Institution or
City Town or Village Town, o.f...Queensbury Street Address ............Rob.ert...Gar.dens...So..:::B.ldg......60A
W Manner of Death ® Natural Cause Accident Homicide Suicideo Undetermined Pending
Circumstances Investigation
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W,
Medical Certifier Name Title
Leonard Busman MD
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Address
Bolton Landing, New York
.:... :............... ..... -
Death Certificate Filed District Number Register Number
City,Town or Village Town of Queensbury
Date Cemetery or Crematory
❑Burial January25 1994 Pine View Cremator
...::::: : .. . ...... Y .... ...
............ . . . . . . .
_ _
®Cremation Address
Queensbury, New York
.:. :: .. : . ::::::: ..
Z Date Place Removed
O ❑ Removal and/or Held
1- and/or Hold ::.........:::: . ......... . ......:. ....... :::..... ....._......
Address
O ......:.: ... ............
a> Date Point of
tn' ❑Transportation by: Shipment
pl Common Carrier .......... _ ........:..:.:.....:.:......... . ......:..
Destination
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El Disinterment Date Cemetery Address
. ...: ::. . ...:: : :.: .... ..::......
❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Firm Regan and Denny Funeral Service, Inc. 01583
...-- ......... .::::........ ...:..
......::, . ......:... . .
Address
26 Quaker Road, Queensbury, New York 12804
>- Name of Funeral Firm Making Disposition or to Whom
gi Remains are Shipped, If Other than Above
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Address
W.
>Zi
Permission is hereby granted to dispose of the hum remains de r'bed above as indicated.
Date Issued / — T-f Registrar of Vital Statistics t
(signature)
District Number � ) Place
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition Place of Disposition
(address)
W
cn (section) (lot number) (grave number)
>r
p' Name of Sexton qr Person in Charge of Premises �
Z- ��' �; (please print)UJI
f
Signature � � �-��2� ^����� --�- �' Title t
DOH-1555 (10/89) p. 1 of 2 VS-61