Rawlins, Margaret i
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
s Name First Middle Last Sex
Margaret Elizabeth Rawlins Female
>; Date of Death Age If Veteran of U.S. Armed Forces,
August 6, 2017 85 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address 63 Indiana Ave
1� Manner of Death Undetermined Pending
iwl 0 Natural Cause �Accident �Homicide n Suicide n n g
Circumstances Investigation
Medical Certifier Name Title
David Cunningham,MD
Address
iiiii Glens Falls,NY
Death Certificate Filed District Number Register Number
s City, Town or Village Queensbury, NY 5657 le,l
®Burial Date Cemetery or Crematory
August 10,2017 Pine View Cemetery
❑Entombment Address
❑Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
ZO 1-1 Removal and/or Held
and/or Address
H Hold
N
O Date Point of
N ❑Transportation Shipment
'p by Common Destination
Carrier
EI
Disinterment Date Cemetery Address
El Reinterment Date Cemetery Address
Permit Issued to Registration Number
• Name of Funeral Home Regan Denny Stafford Funeral Home 01443
0 Address
�f��
«: 53 Quaker Road, Queensbury, NY 12804
r ' 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 rem.' , •escri• - • - •o as ' diy ed.
.r. Date Issued Ce.-Q-apt( Registrar •of Vital •Statistics D 1 O�
,, (Ototr-r%
(signature):' District Number Sicl Place 'I cp t yn r`>M
I certify that the remains of the decedent identified abov ere disposed of in acco •- with this permit on:
Z Q
iii Date of Disposition 2l/D /`� Place of Disposition 2 t c t__../ , ,, ,j 4
Ili (address)
CO ' y,6.
sectio (lot number) (grave number)
00 Name of Sext•, or Person in Charge of Premises (�"' Z. Ei r.
Ill
Z / lease pri
Signature 6 )e. €c 4 Title
(over)
DOH-1555(02/2004)