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Hanson, Mary (I NEW YORK STATE DEPARTMENT OF HEALTH ,. ' , 113 a Vial Records Section Burial - Transit Permit Name First Middle Last Sex Mary C. Hanson Female Date of Death Age If Veteran of U.S.Armed Forces, 1. July 11, 2006 77 War or Dates Z Place of Death Hospital, Institution or W City,Town, or Village Albany Street Address St. Peters Hospital a Manner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑ Pending W Circumstances Investigation U Medical Certifier Name Title W Daniel Kredentser MD a Address 317 S. Manning Blvd. # 280, Albany, NY 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany I 2?. ❑Burial Date Cemetery or Crematory July 13, 2006 Pine View Crematory ❑Entombment Address 2 ❑X Cremation Quaker Road Queensbury, NY 12804 Date Place Removed 0 ❑Removal and/or Held and/or Address Hold 0 Date Point of 0 ❑Transportation Shipment a by Common Destination Carrier Date Cemetery Address a ❑Disinterment El 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, NY 12803 Name of Funeral Firm Making Disposition or to Whom a- Remains are Shipped, If Other than Above W Address Permission is h reb granted to dispose of the human remains described above as indicated. Date Issued f ?( p Registrar of Vital Statistics /yf Q Q, ' e f/I Q 4�` signat e) l-C--- District Number ) 1 Place Ally,New York C F.. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 2 81 Date of Disposition 07/13/2006 Place of Disposition Pine View Crematory 2 (address) kJ 40 1 (section) f < (lot number) (grave number) Name of Sexton or Person in Charge of Premises L r S¢nrat 2 W (please print) Signature 1 Title erL►r*0. (over) DOH-1555 (02/2004)