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Martin, Emily 5- 73 NEW YORK STATE DEPARTMENT OF HEALTH • Vital Records Section Burial - Transit Permit Name First Middle Last Sex Emily S. Martin Female Date of Death Age If Veteran of U.S.Armed Forces, December 23,2006 83 War or Dates Place of Death Hospital, Institution or ZCity,Town or Village Town of Athol Street Address 1544 Stony Creek Road W Manner of Death INNatural Cause ElAccident ElHomicide ElSuicide ElUndetermined ElPending Circumstances Investigation 0 Medical Certifier Name Title tU Aqeel Gellani MD G Address Glens Falls,NY 12801 Death Certificate Filed District Number Register Number City,Town or Village Thurman 5659 ❑ Burial Date Cemetery or Crematory 12/26/2006 Pine View Crematory ❑ Errtombment Address © Cremation Queensbury,NY Date Place Removed ❑ Removal and/or Held • and/or Address j, Hold Date Point of O ❑ Transportation Shipment of by Common Destination " Carrier Date Cemetery Address ❑ D• isinterment Date Cemetery Address ❑ R• enterment Permit Issued to Registration Number Name of Funeral Home Alexander-Baker Funeral Home 00036 Address 3809 Main Street,Warrensburg,NY 12885 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Le ate. Permission is hereby granted to dispose of the human re �% describ abo as i •' . - Date Issued 12-23-06 Registrar of Vital Statistics // y\C r)f2..0 " / (sigrture) District Number 5659 Place Thurman,NY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F , iZ Date of Disposition AA, Place of Disposition , u;lw CrYm,c(f rt Ln. (address) W 0 (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises r;s (tea - (please print) W Signature ( ,iM0 i:l Title cliu ' DOH-1555(02/2004) (over)