Rooke, Betty ' FIEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Betty Rooke Female
Date of Death Age If Veteran of U.S. Armed Forces,
March 30, 2017 83 War or Dates
Place of Death Hospital, Institution or
City, Town or Village South Glens Falls Street Address 8 Prince William Court
Et Manner of Death X❑ Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ri❑ Pending
Lii
Circumstances Investigation
til Medical Certifier Name Title
William Parker, Dr.
Address
48 East Street Fort Edward, NY 12828
Death Certificate Filed District Number Register Number
City, Town or Village South Glens Falls
®Burial Date Cemetery or Crematory
April 4, 2017 Pine View Cemetery
❑Entombment Address
❑Cremation Quaker Road Queensbury,NY 12804
- Date Place Removed
❑ Removal and/or Held
• and/or Address
Hold
Date Point of
a. ❑Transportation Shipment
by Common Destination
• Carrier
Date Cemetery Address
El Disinterment
Date Cemetery Address
❑ Reinterment
Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home-SGF 01078
Address
136 Main Street, South Glens Falls NY 12803
Name of Funeral Firm Making Disposition or to Whom
t Remains are Shipped, If Other than Above
2 Address
fir
#aw.
a- Permission is hereby granted to dispose of the human rem ' describe4.a as indicated.
Date Issued 3i 3 i /17 Registrar of Vital Statistics 7 a 07
�/ ` / signature) ,�`� ��
District Number " 1 5,D L Place V /C c_ ����/ 6��-&S ,tz3`
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
• Date of Disposition 04/04/2017 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
W ction) r, (lot number) (grave number)
ct Name of Se n or Person in Charge of Premises �/l�dt: Cr"
(please f) ��
. _ni111 Signature /U ��-` 0-'.e Title��'���e t����'
T
(over)
DOH-1555 (02/2004)