Dyal, Edith NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last
emale
Edith E. Dal
Date of Death Age If Veteran of U.S. Armed Forces,
January 18, 1996 74 War or Dates no
Place of Death Hospital, Institution or
City, Town or Village town of Queensbury Street Address 6 Hummingbird Lane
Manner of Death®Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
0. Martelo MD
Address
102 Park Street Glens Falls New York
Death Certificate Filed District Number Regis er Number
City, Town or Village Town of Queensbury j(p
Date Cemetery or Crematory
❑Burial January 22, 1996 Pine View Crematory
®Cremation Address Queensbury, New York
Date Place Removed
zRemoval and/or Held
0 and/or Address
Hold
Q Date Point of
❑Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan and Denny Funeral Service, Inc. 01583
Address
53 Quaker Road, Queensbury, New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
s: Permission is hereby granted to dispose of the human emas deTrib ed`a6 a ire' aid.
Date Issued — 'Q(-a Registrar of Vital Statistics
(sig atu
District Number (4�_ Place ✓,�-2�
I certify that the remains of the decedent identified above wer di posed of in accorda with his permit on:
W Date of Disposition Aaa- Place of Disposition
+�, (address)
iU
N
t� (section) (lot nym n� (grave number)
� Name of Sexton or Person in Charge of Premises f� !7
F (please print)
Signature Title
DOH-1555 (10/89) p. 1 of 2 VS-61