Miles, Ida NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Ida S. Miles female
Date of Death Age If Veteran of U.S. Armed Forces,
February 4, 1995 92 War or Dates no
Place of Death Hospital, Institution or
City, Town or Village Town of Queensbury Street Address Hallmark Nursing Centre
Manner of Death®Natural Cause Accident 0 Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Thomas Kandora MD
Address
Upper Broadway, Fort Edward, New York 12828
Death Certificate Filed District Number Reg r Number
City, Town or Village Town of Queensbury
Date Cemetery or Crematory
❑Burial February 7, 1995 Pine View Crematory
Address
F Cremation Queensbury, New York
Date Place Removed
8 Removal and/or Held
•• and/or Address
Hold
Q Date Point of
Q 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.
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
Permission is hereby granted to dispose of the huma a ins de bove s indicated.
gc
Date Issued Registrar of Vital Statisti s
(sig e)
District Number Place
I certify that the remains of the decedent identified above er disposed of in acco ce with is permit o/-n:,
F p � —y U/1�
Date of Dis osition Place of Disposition .� /,� ,� �I-F,-
(address)
UJI
(section) (lot number) / (grave number)
Name of Sexton r Person n Charge of Premises
i (please print)
Signature Title
DOH-1555 (10/89) p. 1 of 2 VS-61