Danforth, Louise NEW YORK STATE DEPARTMENT OF HEALTH ial - TransitPermit
Vital Records Section ;
Name First Middle I 1`.1 IC} t i=p ta-k Sex
Louise E. ,12.a114 rth Female
Date of Death Age If Veteran of U.S.Arme Forces,
January 4, 2006 91 War or Dates
Z Place of Death Hospital, Institution or
W City,Town,or Village Granville Street Address The Orchard Nursing & Rehabilitation
Cl Manner of Death E Natural Cause ❑ Accident ❑ Homicide Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
0 Medical Certifier Name Title
Dr. Daniel P. Garfinkel Dr.
Address
213 Main St. , Salem, NY 12865
Death Certificate Filed District Number Register Number
City,Town or Village Granville
❑ Burial Date Cemetery or Crematory
January 9, 2006 Pine View Crematory
❑ Entombment Address
Cremation Quaker Road Queensbury, NY 12804
Date Place Removed
0 ❑ Removal and/or Held
and/or Address
1' Hold
(i) Date Point of
0 ❑Transportation Shipment
by Common Destination
Carrier
Date Cemetery Address
❑ Disinterment
❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home 01140
Address
123 Main St. , Argyle, New York 12809
Name of Funeral Firm Making Disposition or to Whom
ix Remains are Shipped, If Other than Above
dAddress
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued `I/ 62 II �OC(i, Registrar of Vital Statistics -f
(J(s jg ture)
District Number cl5L0 Place Granville,New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 01/09/2006 Place of Disposition Pine View Crematory
W (address)
to
(section) of number) (grave number)
Z Name of Sexton or Person in Charge of Premises &t�-�',L J rt 74
- ,/ lease print)
W C A Signature -dt/"Yam. Title (�R Ey✓l'Y. 4- I�
/' (over)
DOH-1555 (02/2004)