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Raymond, Delia NEW YORK STATE DEPARTMEN-r OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Delia A. Raymond female Date of Death Age If Veteran of U.S. Armed Forces, Dec. 26, 1997 72 War or Dates no Place of Death Hospital, Institution or Adirondack City, Town or Village North Creek Street Address Tri-Co. Health Care Center Manner of Death©Natural Cause Accident Homicide Q Suicide Undetermined Pending Circumstances Investigation Medical Certifier Narm Title Addres Death Certificat Filed / District Number Regist r tuber Q41*, Town oft Yl S16 Date Cemetery or Crematory ❑Burial 12/30/97 Pine View Crematory Address Crefr;atiur'i Queerisbury,, NY Date Place Removed Z❑Removal and/or Held .- and/or Address Hold Date Point of Q 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 Home 01565 Address 53 Quaker Road, Queensbury, NY 12804 X Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address V. Permission is hereby gr nted to dispose of the human re ains described abovVas, dicated. Date Issued / Registrar of Vital Statistics 4 ignatur ) District Number Plac I certify that the remains of the decedent identified a e we a disposed of in accor ce with this permit on: Date of Disposition �� Place of Disposition._ - N• I � � (address) iu (section) (lot n tub r _ ) (grave number) Name of Sexto or Person in Charge of Premises (please print) �j �r Signature Title%� /l DOH-1555 (10/89) p. 1 of 2 VS-61