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Rahill, Agnes NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Agnes N Rahill Female Date of Death Age If Veteran of U.S. Armed Forces, 09/07/2018 75 Years War or Dates H Place of Death Hospital, Institution or Z City, Town or Village Queensbury Town Street Address The Stanton Nursing And Rehabilitation Centre p Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title Suzanne Blood MD Address 152 Sherman Ave,Queensbury Town,New York 12801 Death Certificate Filed District Number Register Number City, Town or Village Queensbury 5657 126 gBurial Date Cemetery or Crematory 09/11/2018 Pine View Cemetery El Entombment Address ['Cremation Queensbury, New York Date Place Removed 0❑Removal and/or Held and/or Address ~' Hold rA 0 Date Point of N❑Transportation Shipment G by Common Destination Carrier ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom I_ Remains are Shipped, If Other than Above 2 Address LU Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/10/2018 Registrar of Vital Statistics Caroline 7fBarfer(ECectronica(CySigned) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 9/1 1 /201 Place of Disposition Pine View Cemetery Queens»ry W (address) N Erie 79-1=1 2 (section) (lot number) (grave number) pName of Se ton or Person in Charge of Premises Connie Goedert (please print) W Signatur k '—e ` " Title Cemetery Superintendent (over) DOH-1555 (02/2004)