Porter, Helen NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Helen V. Porter Female
Date of Death Age If Veteran of U.S. Armed Forces,
Dec. 11, 1995 71 Yrs. War or Dates
Place of Death Hospital, Institution or
City, Town or Village Schenectady Street Address Ellis Hospital
Manner of Death Natural Cause Accident Homicide F]Suicide ElUndetermined Pending
Circumstances Investigation
Medical Certifier Name Title
David Armerit MD
Address
2546 Balltown Road Schenectady, NY 12308
Death Certificate Filed District Number Register Number
City, Town or Village Schenectady 4601
Date Cemetery or Crematory
❑Burial December 14, 1995 Pineview Crematory
Address
®Cremation Queensbury, New York
Date Place Removed
Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
X.
Name of Funeral Home Stafford Funeral Home 01851
Address
90 Montcalm ST., Lake George, New York 12845
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 r ain de ribed above as indicat d.
Date Issued 12-12-95 Registrar of Vital Statistics
si nature) o
District Number 4601 Place Schenectady, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition lk
Place of Disposition41-
A(address)
(se ton �(Mlotnube ` ) (grave number)
Name of Sexton r Person in Charge of remises k/
- (please print)
SignatureL Title �lJ
DOH-1555 (10/89) p. 1 of 2 VS-61