Bates, Loren —ND,
YORK STATE DEPARTMENT OF HEALTH
yVital Records Section Burial - Transit Permit
Name First Middle Last Sex
Loren 0. Bates male
Date of Death Age If Veteran of U.S. Armed Forces,
April 25, 1994 66 War or Dates Yes
Place of Death Hospital, Institution or
City, Town or Village Town of Queensbury Street Address 50 Farr Lane
Manner of Death ❑Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Daniel Larson MD
Address
Death Certificate Filed District Number Regist�r�umber
City, Town or Village Town of Queensbury
Date Cemetery or Crematory
❑Burial April 27, 1994 Pine View Cremator
Address
®Cremation Queensbury, New York 12804
Date Place Removed
8 ❑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 Denny Funeral Service, Inc. 01583
Address 26 Quaker Road, Queensbury, New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
IZ
Permission is hereby granted to dispose of the human .e ins escri ove as ' cate .
Date Issued` fj '�( Registrar of Vita! Statisti
ture)
District Number Place
I certify that the remains of the decedent identified above w re isposed of in aecordance ith this permit on'.
zW.
Date of Disposition Place of Disposition i
(address)
k0Name
(section) (lot number) grave number)
of Sexton Person i Charge of Pre ises (please print),,..,,,,gnature Title t SJ✓
DOH-1555 (10/89) p. 1 of 2 VS-61