Comar, Loretta NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial " Transit Permit
Name First Middle Last Sex
LORETTA J. COMAR Female
Date of Death Age If Veteran of U.S.Armed Forces,
July 16, 1995 68 War or Dates none
Place of Death Hospital, Institution or
City, Town or Village Glens Falls, NY Street Address Glens Falls Hospital
Manner of Death x Natural Cause n Accident []Homicide n Suicide Undetermined Pending
Circumstances Investigation
f` Medical Certifier Name Title
Bernardo R. Villajuan, M.D.
Address
90 South Street Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls, NY 5601 3 60
Date Cemetery or Crematory
❑Burial July 18, 1995 Pine View Cremator
Address
Cremation Quaker Road Queensbury, NY 12804
Date Place Removed
tr
(�C]Removal and/or Held
r- and/or Address
Hold
Date Point of
[]Transportation Shipment
p by Common Destination
Carrier
Ej Disinterment Date Cemetery Address
[]Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton-Healy Funeral Home, INc. 01807
Address
407 Bay 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 humah remains described above as Indic d.
Date Issued July 18, 1995Registrar of Vital Statistics ? ~f
may,
(signature)
District Number 5601 Place City of Glens Falls, NY 12801
f certify that the remains of the decedent identified above were disposed of In accordance with this permit on:
Date of Disposition Place of DispositioniV.�' aC"!�'
(address)
t� (se t� �l �o nu be�)� (grave number)
f�tame of Sexto or Perso in Charge of emises , �
(please print)
Signature " Title
DOH-1555 (10/89) p. 1 of 2 VS-61