McIntyre, Mary NEW YORK STATE DEPARTMENT OF HEALTH-
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Vital Records Section s p Burial - Transit Permit
Name First ( Middle Last Sex
Mary Esther McIntyre Female
Date of Death Age If Veteran of U.S. Armed Forces,
August 14, 2018 32 War or Dates
-` Place of Death „----- Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death ❑Natural Cause X❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
Medical Certifier Name Title
Paul F. Bachman, ME
Address
Warrensburg, NY 12885
Death Certificate Filed District Number Register umber
City, Town or Village Glens Falls (420% 4
❑Burial Date Cemetery or Crematory
August 16, 2018 Pine View Crematory
_' ❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
. ❑ Removal and/or Held
and/or Address
Hold
i' Date Point of
❑Transportation Shipment _
by Common Destination
Carrier
ElDisinterment Date Cemetery Address
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
. , Remains are Shipped, If Other than Above
Address
.; Permission is he eb granted to dispose of the huma remains described ovvee as ndica d.
Date Issued Q Registrar of Vital Statistics ,2. �// Oa.
' (signature)
District Number Place 4 ), €.6
I certify that the remains of the decedent identified above were disposed of in accordan with this permit on:
Date of Disposition 08/16/2018 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
OA
IIZ (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises -rtim y 3 tuor J3
(please print)
Signature i Title C rt.wig 4.Gr
(over)
DOH-1555 (02/2004)