Gifford, Margaret NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Biostatistics-Vital Records Section
Name First Middle Last Sex
Mii
Margaret L. Gifford Female_
Date of Death Age If Veteran of U.S.Armed Forces,
August 31, 1987•
75 War or Dates No
Place of Death : Hospital, Institution or
fU City,Town or Village Glens Falls, New York Street Address Glens Falls Hos_ital_
D Cause�of�Deatli
Probable C.V.A.-Poss. Hemorrhage Cerebro Vascular A.S. Gen. A.S...
Itl Medical Certifier Name Title
Q Harold J.Iam Addressia M.D.
::.:.::.........:.:::...._............. .:....................._..... .........................__....._............._....._.....
::::<::::;
25 May Street Glens Falls New York 12801
< Death Certificate Filed District Number................................................ Regiister Number
iiN City,Town or Village Glens Falls New York 5601 /3_��
Date Cemetery or Crematory
®Burial ` September � Pvnevi.tember 2 1987 ........� Cemet
ery
ete
........ c...:: ry
.:. .......:.:.::...:::..:.:..:......... .......::....::......:::............
❑Cremation Address
Queens bury, New York
Z Date Place Removed
O 0 Removal and/or Held
and/or Hold>,.:::::::::::::::::::::::..:::::::::::.:.:.:::::::::::::::.::::.:::::::::::::::._:;>:::.::::::.:..:::::::::::.....:::......::::::::::::::::::::::::::•...:::............:......:::::::::::::::::::::::........................
F_-: Address
all
11. Date Point of
cn 0 Transportation by Shipment
Common Carrier
Destination
❑ Disinterment
` Date Cemetery Address
Date.... Cemetery Address..............:..............:.......................................................................
❑ Reinterment ii
Permit Issued to Registration Number
Name of Funeral Firm James F. Singleton Inc. 02285
Address
>^c> 314 BayRoad P.O. Box 681 Glens Falls New York
; ; Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
iIr Address
Ilii
0.:
Permission is hereby granted to dispose of the dead h an re ains des bed above as indicated.
Date Issued 9/1/87 Registrar of Vital Statistics t `� ,ct Z.d.uL' -e--
ignature) r
oiii District Number 5601 Place Glens Falls, New York - /j.f0).
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F.-
Z Date of Disposition 7_2-87 Place of Disposition P'iv-e t" `,'IA) C. VIA-e-i-r t, q.a .e e\•511,,4.I.LI
)
w S .dress 2- / l ( - 1
C> (section (lot number) (grave number)
pName of S n or arson in Charge of Premises K_<`',ck N I E--. Y / \O S ke 1-
Z (please print)
111
' Signatur 4 ..[lam I- ,L,,v Title 'V VT
DOH- 1555(9/86)p 1 of 2(formerly VS-61)