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Washburn, Mabel NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Mabel Augusta Washburn Female Date of Death Age If Veteran of U.S.Armed Forces, 05/27/2018 92 Years War or Dates Place of Death Hospital, Institution or 7 City, Town or Village Granville Village Street Address Indian River Rehabilitation And Nursing Center , p Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ri❑Pending 11 Circumstances Investigation w Medical Certifier Name Title 0 Sean Bain MD Address 17 Madison St,Granville Village,New York 12832 Death Certificate Filed District Number Register Number -:F City, Town or Village Granville Village 5725 24 ['Burial Date Cemetery or Crematory 05/31/2018 Pine View Crematory DEntombment Address ®Cremation Queensbury Town, New York Date Place Removed 9 El❑Removal and/or Held and/or Address J[- Hold ,U) dDate Point of N❑Transportation Shipment 13 by Common Destination ' Carrier ❑Disinterment Date Cemetery Address ❑Renterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077 Address 123 Main St,Argyle,New York 12809 Name of Funeral Firm Making Disposition or to Whom I Remains are Shipped, If Other than Above Address II a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/30/2018 Registrar of Vital Statistics Rickard'g6erts(E(ectronica((ySigned) (signature) District Number 5725 Place Granville Village, New York E,, I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition ill 1 i s Place of Disposition ?In IL ifsiv cc". I (address) LLI IZ (section) (I number) r (grave number) G Name of Sexton or Person in Charge of Premises "4 a e print) z W Signature di� Title (P' (over) DOH-1555 (02/2004)