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Akins, Emiley t NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit N• ame First Middle Last Sex Emiley M. Akins Female Date of Death Age If Veteran of U.S.Armed Forces, NO A• ugust 28,2006 70 War or Dates Place of Death Hospital, Institution or City, Town or Village City of Glens Falls Street Address Glens Falls Hospital Manner of Death ❑X Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending Circumstances Investigation t Medical Certifier Name Title Christopher D.Hoy Dr. , Address 102 Park St,Glens Falls,NY 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 0 Burial Date Cemetery or Crematory 8/31/2006 Pine View Cemetery ❑ Entombment Address 0 Cremation Queensbury,NY Date Place Removed Z El Removal and/or Held O and/or Address l- Hold dN1-1 Date Point of ❑ Transportation Shipment U) by Common Destination C Carrier Date Cemetery Address ❑ Disinterment Date Cemetery Address ❑ Reinterment Permit Issued to Registration Number Name of Funeral Home Singleton-Healy Funeral Home 01682 Address 407 Bay Road,Queensbury,NY 12804 Name of Funeral Firm Making Disposition or to Whom • Remains are Shipped, If Other than Above Address at tu cli Permission is her v_ anted to dispose of the human re ains des ribed abo(&as indicat Date Issued © Registrar of Vital Statistics i ----- 1 '2 L "� 14 ( ' nature) . District Number 5601 Place Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I-- Z Date of Disposition 8/31/06 Place of Disposition P I NF VI FW CFMFTFRY,CAI IFENSBURY NY LV (address) W MOHICAN 68-B 2 co (section) (lot number) (grave number) Cd O Name of Sexton or Person in Charge of Premises M I CHAEL BEN I ER CI (please print) Z - W Signature .VJwW" Title SUPT. DOH-1555 (02/2004) (over)