Wilson, Margaret NEW YORK STATE DEPARTMENT OFHEALTH ��U8�~��D ~ ���%�����^� Permit
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Name First Middle Last
Sex
Margaret A. Wilson
Age
If Veteran of U.S. Armed Forces,
April 17, 1993 43 War or Dates None
z. Place of Death Hospital, Institution or
W City,Town or Village Queensbury, NY Street Address
anner of Death
Natural Cause [:] Accident Homicide El Suicide Circumstances L-J Investigation
Medical Certifier Name Title......
Address -----------------------------'---------
District Number Register Number
City,Town or Village Oueensburv, MY 5657
Date Cemetery or Crematory
Luzerne Road
�--- -~-- Date Place
_,____^_ ___�____
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__ ^� � and/or Held
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cL Date Point of '
wn Transportation by "
�- Common Carrier ' Shipment
Destination
~_~~^ '_._-_-
El Disinterment Date Cemetery Address
Fl Reinterment Date Cemetery Address
Permit Issued to
Registration Number
Name of Funeral Firm James F. Singleton, Tnc.
Address
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission Is hereby granted to dispose of the human ins described ab ve ndicated.
Date Issued APr 19, 1993 Registrar of Vital Statistics
District Number 5657 Place Town of Queensbury
/oortify that the remains of the decedent identified above were disposed nfin accordance with this permit un:
Date ofDisposition 4/30/9 3 Place of Disposition 3t. Alphonsus Cemetery, Corner Pine St., & Luoezne 86
Z (address)
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cc (section) (lot number) (grave number)
'0 Name f Sexto or Person inCho /'ex Rev. Robert Powlzida
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= Gign�guro^~\~, �K�'./^�� [ ~�~_� Th|o Pastor .
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DOH'1655 (10/89) p. 1of2 VS'61
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