Durkee, Pauline t -NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit
Vital Records Section Permit
Name First Middle Last Sex
Pauline Virginia Durkee Female
Date of Death Age If Veteran of U.S.Armed Forces,
1. March 17, 2006 77 War or Dates
Z Place of Death Hospital, Institution or
W City,Town,or Village Glens Falls Street Address Glens Falls Hospital
0 Manner of Death ❑ Natural Cause 0 Accident ❑ Homicide ❑Suicide 0 Undetermined ❑ Pending
W Circumstances Investigation
() Medical Certifier Name Title
W Dr. Paul F. Bachman, M.D. Dr.
0 Address
3767 Main St. , Warrensburg, NY 12885
Death Certificate Filed District Number 5.470/ Register Number
City,Town or Village Glens Falls /u.-
❑R Burial Date Cemetery or Crematory
March 23, 2006 Pine View Cemetery
❑Entombment Address
Z ❑Cremation Quaker Road Queensbury, NY 12804
Date Place Removed
4 0 Removal and/or Held
- and/or Address
Hold
11 Date Point of
4 El Transportation Shipment
i by Common Destination
Carrier
Date Cemetery Address
o ❑Disinterment
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home 01141
Address
136 Main Street, South Glens Falls, New York 12803
1-
Name of Funeral Firm Making Disposition or to Whom
2 Remains are Shipped, If Other than Above
I/
W Address
0.
Permission is hereby granted/ to dispose of the human remains described above s ind' e .
Date Issued O3/Z3/OC Registrar of Vital Statistics
(signature)
District Number „1-6 0/ Place Glens Falls,New York
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
Lu• Date of Disposition 03/23/2006 Place of Disposition Pine View Cemetery
(address)
V) SENECA 10-C 1
it (section) (lot number) (grave number)
0
• Name of Sexton or Person in Charge of Premises M I CHAEL BEN I ER
Z (please print)
tu Signature 2 /,A.MP- Title SUPT.
(over)
DOH-1555 (02/2004)