Duell, Lillian NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
Lillian Bell Duell Female
i;;;? Date of Death Age If Veteran of U.S. Armed Forces,
.........:....July 6, 1994 84 War or Dates no
2 Place of Death Hospital, Institution or
la City,Town or Village City of Glens Falls Street Address Glens Falls Hospital
�� Circumstances Manner of Death ® Natural Cause Accident ❑Homicide � Suicide UndeterminedQ Pending
Investigation
iiiMedical Certifier Name Title
fl
.............. Pat..r.i.cia...H.ale..:........7.2.4.0:...Up.p.er....B.r:o.a:dw.a.y:...F.or.t..E.dw.a.r..d., .Ne.w....York:::.1.2.8..28
Address
Death Certificate Filed District Number Register Numberr,,
City,Town or Village City of Glens Falls 6 L1
Date Cemetery or Crematory
Burial July 9, 19994 St. Alphonsus Cem.
Cremation Address
Tn. of Queensbury, New York
•Z Date _Place Removed **
OD Removal and/or Held
F-; and/or Hold ,.:......;•e..:..:......:..................:.. ..:.. ...
Address
Cl)
O.:::::.:..........::........:::::......::....:..:..:..........:..:.......:...........
.........:.........
oL Date Point of
0 ['Transportation by
pi Common Carrier Shipment
Destination
[' Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Niii Permit Issued to ; Registration Number
eV Name of Funeral Firm M. B. Kilmer Funeral Home 01057
iiiiiiiiiii Address
......: 136 Main St. South Glens Falls, New York 12803
Name of Funeral Firm MakingDispositionhom
or to Whom
g Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the hums remains described above as
gas indicated.
iiiiiiiiiii Date Issued 7-7-94 Registrar of Vital Statistics ) ��41 - (Q ll�2.....
(signature)
District Number 5 l Place City of GLens Falls , New York
I certify that the remains of the decedent identified above were disposed of in accordance wi t ervion:
H St. & Luzerne Rd.
•Z: Date of Disposition 7/9/9 4 Place of Disposition St. Alphonsus Cemetery, Queensbury, NY 12804
Au
2 (address)
W` Section "E" 7 6
CC (section) (lot number) (grave number)
pName of Sext nor Person in Charge of,Rremi s Rev. Robert W. Powhida
Z
W / L 'J (please print)
Signatures �� `�• r A,-;=/ 'C- Title Pastor
DOH-1555 (10/89) p. 1 of 2 VS-61