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Raprager, Cecil NEW YORK STATE DEPARTMENT OF HEALTH Burial _ Transit Permit Vital Records Section Name First Middle Last Sex ::44 Cecil Noel Raprager Male Date of Death Age If Veteran of U.S. Armed Forces, August 19, 2018 63 War or Dates NO Place of Death Hospital, Institution or 7. City, Town or Village Argyle Street Address 16 Allen Road *k Manner of Death5 Undetermined Pending - Natural Cause Accident Homicide Suicide n Circumstances Investigation Medical Certifier ea,a,me \/ . `0.4 6 eo 4 dggi 1 r,491trss 5-, 134 aq GreeduuAd4 kg 17R2.3y w Death Certificate Filed District Number Register umber n.City, Town or Village Argyle -5� accop ' Date Cemetery or Crematory ❑Burial August 21, 2018 Pine View Crematory L]Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 -i Date Place Removed ❑Removal and/or Held and/or Address • Hold 4 Date Point of • ❑Transportation Shipment • by Common Destination • Carrier ii ill Disinterment Date Cemetery Address Reinterment Date Cemetery Address a 4 Permit Issued to Registration Number ' Name of Funeral Home M. B. Kilmer Funeral Home-Argyle 01077 ` t Address 123 Main St., Argyle NY 12809 l Name of Funeral Firm Making Disposition or to Whom e' Remains are Shipped, If Other than Above Address 104 Permission is hereby granted to dispose of the human r , ains described aboo e-;as in c ed. Registrar of Vital Statistics c \N\ � - =' Date Issued �S-�-�"o�C>>�Re 9 �� � c cc (signature) tS. District Number T61 -- 0 Place \C_)wN-\ c s , I certify that the remains of the decedent identified above were disposed o in accordance with this permit on: Date-of Disposition 08/21/2018 Place of Disposition Quaker Road Queensbury,NY 12804 (address) g (section) (lot number) (grave number) tea_ Name of Sexton or Person in Charge of Premises 3Cuf ,y SQL:rc,S (please print) Signature �� Title Gfe, }a,f (over) DOH-1555(02/2004)