Jameson,Marian NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Jameson female
Date of Death Age If Veteran of U.S. Armed Forces,
May 27, 1994 82 War or Dates no
Place of Death Hospital, Institution or
City, Town or Village City of Glens Falls Street Address Glens Falls Hospital
Manner of Death®Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Address
102 Park Street Glens Falls N. Y. 12801
Death Certificate Filed District Number Register Number
City, Town or Village City of Glens Falls �O
Date Cemetery or Crematory
❑Burial
Address
X❑Cremation Queensbury,, New York
Date Place Removed
Z❑Removal and/or Held
�. and/or Address
Hold
0❑ Date Point of
Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
[E]Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan andDenny
«. 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
Permission is hereby granted to dispose of the human re dins ibed above as indicated.
Date Issued ,�`' Registrar of Vital Statis s
�signat;�r e`
r
District Number p/ Place
I certify that the remains of the decedent identified above were dispos of in accordance with this permit on:
Date of Disposition - "�� Place of Disposition
W. (address)
LLI
t� (section) n (lot number) (grave number)
GName of Sexton or Pers in Charge of Premises ���/(�
g (please print)
W Signature Title �✓ /� �l ! r
DOH-1555 (10/89) p. 1 of 2 VS-61