Monger, Margaret NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
R. Margaret Monger Female
[ Date of Death Age If Veteran of U.S. Armed Forces,
8-19-95 81 War or Dates N/A
Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address Hallmark Nursing Centre
Manner of Death Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Ir
Thomas Kandora MD
Address
Broadway Fort Edward, NY
Death Certificate Filed District Number Register Number
City, Town or Village Queensbury
Date Cemetery or Crematory
❑Burial 8-21-95 Pine View Cremator
Address
®Cremation Queensbury, NY
Date Place Removed
Z ❑Removal and/or Held
.•. 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 & DennyFuneral Home 01583
Address
Queensbury, NY 12804
s 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 remai described ab as indicated.
:[ Date Issued )-1 5 Registrar of Vital Statistics G�
(signature)
District Number f-2 Place
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition�� Place of Disposition
(address)
LLI
{s ction) (lot ur er) (grave number)
0 Name of Sexto r Person Charge of Premises
(please print)
Signature Title
DOH-1555 (10/89) p. 1 of 2 VS-61