Euber, Mary NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
5= Name First Middle Last Sex
Mary Lilly Blossom Euber Female
: Date of Death Age If Veteran of U.S. Armed Forces,
June 10,2015 77 War or Dates
} Place of Death Hospital, Institution or
Z City, Town or Village Thurman Street Address 128 Bowen Hill Rd.
aManner of Death I X)Natural Cause Accident n Homicide Suicide Undetermined Pending
LU Circumstances Investigation
ut Medical Certifier Name Title
. Mary Kilayko MD
Address
j HHHN,Queensbury,NY 12804
Death Certificate Filed District Number Register Number
City, Town or Village Thurman 565941
Ix Burial Date Cemetery or Crematory
June 15,2015 St. Alphonsus Cemetery
1 Entombment Address
❑Cremation Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
F' Hold
u)
O Date Point of
yTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
I Reinterment Date Cemetery Address
" Permit Issued to Registration Number
Name of Funeral Home Alexander Funeral Home 00037
y Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above Carleton FH,Inc.
Address
68 Main St.,Hudson Falls,NY 12839
a,
. Permission is hereby granted to dispose of the human r ins d s ribed abov ' dic ted.
Date Issued C6 /$ /5" Registrar of Vital Statistics
(signature) J
District Number 5659 Place Thurman
I certifythat the remains of the decedent identified above w e disposed fin ac rdance with this er ton:
q � �n
W Date of Disposition LPJ Si if Place of Disposition \V..-....Ft
E (address)
W
CO
7
O (s b ) (lot number) (grave number)
Q Name of Sexton or Person in Charge of Premises
Ili7.z (please-C��/p Tint)
2Signature Title t41 y
(over)
DOH-1555 (02/2004)