Knauss, Mary w
'ANEW$ORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Mary G. Knauss female
Date of Death Age If Veteran of U.S. Armed Forces,
January 14, 1997 84 War or Dates
no
Place of Death Hospital, Institution or
City, Town or Village City of Glens Street Address Glens Fall.-, Hn-,pital
:. Manner of Death®Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Gerald MD
Ad ress
Irongate Center, Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village City of Glens Falls s6o 1 2,
Date Cemetery or Crematory
❑Burial Jan. 17 199
Address
l Cremation Queensbury,, New York
gDate Place Removed
❑Removal and/or Held
••• and/or Address
Hold
JRDate Point of
❑Transportation Shipment
by Common Destination
Carrier
❑Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
01583
Name of Funeral Home Regan and denny Funeral Service, 1AG.
Address 53 Quaker Road, Queensbury, NY 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 remains descri a ab ve in ted.
Date Issued 11161ct7 Registrar of Vital Statistics
(signatur )
District Number S 6� Place G1� S V('\\ S NY l a� O 1
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
f-
Date of Disposition �:O Place of Disposition j/\/1 Y 1 l° IAI C re a a_'Po- r
(address)
(section) lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises /� ! C� �/�� L 0�e2
a (please print) _
Signature Title c r e m 41'd r 7 1�-5S i d
DOH-1555 (10/89) p. 1 of 2 VS-61