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Watson, Eleanor g NEW YORK STATE DEPARTMENT OF HEALTH w I$ Vital Records Section Burial - Transit Permit Name First Middle Last Sex Eleanor Elaine Watson Female Date of Death Age If Veteran of U.S. Armed Forces, February 28, 2018 74 War or Dates Place of Death Hospital, Institution or En City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Deathm Lu Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ri❑ Pending tit €I Circumstances Investigation 0111 Medical Certifier Name Title Christopher D. Hoy, M.D. Dr. Address 102 Park St. Glens Falls, NY 12801 Death Certificate Filed District Number f���. Register Number City, Town or Village Glens Falls S f7) I 1 1 I ❑Burial Date Cemetery or Crematory March 1, 2018 Pine View Crematory ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed ❑ Removal and/or Held and/or Address Hold in Date Point of Cf ❑Transportation Shipment 0 by Common Destination 0! Carrier Date Cemetery Address ❑ Disinterment Date Cemetery Address ❑ Reinterment Permit Issued to Registration Number Name of Funeral Home M. B. Kilmer Funeral Home- FE 01079 Address 82 Broadway, Fort Edward NY 12828 ;,' Name of Funeral Firm Making Disposition or to Whom 5 Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 3 ) 1 12-01 g Registrar of Vital Statistics �7Cc r "-\11. Lv (signature District Number 5 60 f Place 6 S rcA I < S , (J‘.17 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 03/01/2018 Place of Disposition Quaker Road Queensbury,NY 12804 (address) al (section) net number)5 ' 41 (grave number) 2 Name of Sexton or Perso in Charge of remises � l X r(plAase print) sit Rail Signature Title ItfiR (over) DOH-1555 (02/2004)