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NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Steven Alvin Totten Male
Date of Death Age If Veteran of U.S. Armed Forces,
02/14/2018 59 Years War or Dates 1976-78
9 Place of Death Hospital, Institution or
City, Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare
Manner of Death Natural Cause 0 Accident 0 Homicide El Suicide El Undetermined El Pending
Circumstances Investigation
wl Medical Certifier Name Title
Edit Masaba MD
Address
4573 State Route 40,Argyle Town,New York 12809
Death Certificate Filed District Number Register Number
City, Town or Village Argyle 5750 4
❑Burial Date Cemetery or Crematory
02/16/2018 Pine View Crematory
-'❑Entombment
Address
®Cremation Queensbury Town, New York
Date Place Removed
Removal and/or Held
' and/or Address
Hold
Date Point of
Transportation Shipment
by Common Destination
Carrier
[l Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
it LiXi
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
Remains are Shipped, If Other than Above
Address
® Permission is hereby granted to dispose of the human remains described above as indicated.
OS Date Issued 02/14/2018 Registrar of Vital Statistics Shelley Mtckernon(EfectronicalCy Signed)
iti
os (signature)
` District Number Place
5750 Argyle, New York
41,1
certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
DI Date of Disposition, —iC-A i Place of Disposition Pot, V,t,t„, C_,t 2rk-y
(address)
mi
s (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises J e,S'nc,y sew,r�5
(please print)
x Signature A.,„,--
Title cdfiiM')ici
(over)
DOH-1555 (02/2004)