Osborne, Lillian NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Lillian B. Osborne F
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_.
bate of Death Age
If Veteran of U.S.Armed Forces,
11 2 94 89 War or Dates NA
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Place of Death Hospital, Institution or
.
City,Town or Village Queensbury Street Address Hallmark NH
w Manner of Death Natural Cause ❑ Accident ❑Homicide ❑ Suicide Undetermined a Pending
Circumstances Investigation
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W Medical Certifier Name Title
p: T. Kandora MID
.:...: ..............
Address
Ft.Edward,NY
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Death Certificate Filed District Number Regiist�f_umber
City,Town or Village Queensbury 5657
Date Cemetery or Crematory
❑Burial 11-7-94 Pine View Crematory
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®Cremation Address Queensb NY
Y,
Z..... Date Place Removed
Ojl [] Removal and/or Held
F- and/or Hold .......... -::: _::::::.
O!:,:: ..:.:.
' Date..::: Point of .
13.
Ln []Transportation by
a Common Carrier Shipment
-:.::::
Destination
Disinterment
Date Cemetery Address
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Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Firm Alexander—Baker FH 00018
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Address
Warrensburg,NY
t— Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, if Other than Above
'....Address
w.
Permission is hereby granted to dispose of the hu emafns des " ed above as indicated.
Date Issued 11-3-94 Registrar of Vital Statistics Q
re)
District Number 5657 Place T/O Queensbury,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition .�L Place of Disposition jr/� `1/,L� .�/flrjfGB /f/�
(address)
w>
cc (section) (lot number) (grave number)
p' Name of Sexton Person in Charge of Premise /�i��'
z (please print) t
w Signature s1 Title �► t
DOH-1555 (10/89) p. 1 of 2 VS-61