Durkin, Kathryn 2
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Kathryn M. Durkin - Female
Date of Death Age If Veteran of U.S.Armed Forces,
June 19,2006 75 War or Dates
Place of Death Hospital, Institution or
IZ City,Town or Village Street Address
W Manner of Death Q Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
0 Circumstances Investigation
VMedical Certifier Name Title
WCI Dr.Nancy Camey MD
Address
HHHN,Wrg.,NY 12885-
Death Certificate Filed District Number RegisterNumber
City,Town or Village Glens Falls 5601
❑ Burial Date Cemetery or Crematory
6/21/2006 Pine View Crematory
❑ Entombment Address
Q Cremation Queensbury,NY
Date Place Removed
Z ❑ Removal and/or Held
p and/or Address
H Hold
N Date Point of
a ❑ Transportation Shipment
to by Common Destination
0 Carrier
Date Cemetery Address
❑ Disinterment
Date Cemetery Address
❑ Reinterment
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
IZ
dPermission is hereby granted to dispose of the human remains descr �,'abve a nd'
Date Issued 6-20-06 Registrar of Vital Statistics 1� ��'� -
(signature)
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
t.. ) Vi'E c J OR +iA ' 0A\
Z Date of Disposition 6-2 1-4ll Place of Disposition �� �
W (address)
M
III
U) (section) (lot number) (grave number)
O Name of Sexton or Person in Charge of Premises
I-� �R4 t,i
0 Z (please print)
W Signature CO r �!--zzi-,i,61-- Title G"17_5/K4+c k
DOH-1555(02/2004) (over)