Ferris, Florence NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Florence Helen Ferris Female
Date of Death Age If Veteran of U.S. Armed Forces,
June 25, 1995 84 War or Dates
P e of Death Hospital, Institution or
it Town or Village Glens Falls Street Address Glens Falls Hospital
anner of Death X❑Natural Cause ❑Accident [:]Homicide [:]Suicide [:]Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Kichael J. Crook KD
Address
62 Elm St., Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
Cit own or Village Glens Falls 5601
Date Cemetery 4 Crematory
❑Burial June 26, 1995 Pine View Crematorium
Address
>: Nbremation Tn of Aueensbury, MY 12804
Date Place Removed
8❑Removal and/or Held
and/or Address
Hold
Q Date Point of
N ❑Transportation Shipment
by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Howe Inc. 00310
Address
P.O. Box 67, 68 Kain St., Hudson Falls, K.Y. 12839
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 described above as in ic_atted.
Date Issued - ��3 Registrar of Vital Statistics ��
(signature)
District Number Place O
IZ
I certify that the remains of the decedent identified above were dispo of in accordance with this permit on:
f-
W Date of Disposition (����- Place of Disposition NAj e, 0 j e up, G l`e,/b a-T-o rY
.2 (address)
UJI
N
>i (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises m ;r h
g (please print)
Signature Title Asr4,C-
DOH-1555 (10/89) p. 1 of 2 VS-61