Whible, Aubrey * -no
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Station Burial - Transit Permit
Name First Aubr� Middle Lml Smr
Female
Date of OeaN Age If Veteran W U.S. Armed Forma,
06I2L2020 0 ea Waz or palm
0. Place of Users Hospital, IrnM1tulien or z Ciry. T M Streal AddressFall
jManner of Death❑Next Cause QAcddent Homicide Q Suicide L]Undetermmet LjPendirrg
UJ
Clrwmsmncm Imes '
Medical CerM1fieY Name Title
Potential Decline, M 0
Address
100 Park Street Glens FLis, Ny 12801
Death CertiBcam Filed Dii Number Register Numleer
Ciry, T Mm`❑Burial Dam Cememry or Crematory
DEnmmbeart Address
Dicematlon Queen libu NY 1280A
pate Place Removed
ano l or
H
andbor SM
Hold
Address
Hob
Date Po W
�Transporfedon Stri rat
by Common Destination
Caner
Disinterment Gets Demelery Address
E]Procurment Dee Cememry AtldMss
Permit Issued W Regutrafon Number
Name of Fum Home M B Kilmer Funeral Home Ot0y0
Address
828res" Fort Edaartl M
Name W Funeral Finn Making DisposNm m W`Mlam
f Remains are SM . If Other Men Above
Address
6
W
d Permission is hereby granted m dialaw of Me human remains tleMbed isbaearls Indlsuyluel.
Date Issued Ci i25r202o Regislrm OVIBISbtis4m AC 4� 2 ke2� /t^K"CI
District Number �g1 PuriPlans FallsW if
I certify Nature Mears of tM1e dreaded idenlRed above Mrere di iposed M in verb
this plead An:
Date :
Dale of Dgposi0on yliyrl0 Piece of pisp Wmr Y I) Nr�
-mil
(Mercer �m/M�ru-�w�1 (Mwrwrovl
Name of Sordon or Person In Cb Me of Prom r^ ' - � 'W
Signature Title C/ta
(aver)
DOH-1555 (02 C04)
Rer-0�ps ' a>(2ry�
01395j
Human``mains of
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