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MacPherson, Elizabeth NEW YORK STATE DEPARTMENT OF HEALTH - -i # D '" Vital Records Section Burial - Transit Permit Name First Middle Last Sex Elizabeth MacPherson Female .: Date of Death Age If Veteran of U.S. Armed Forces, 10/25/2018 78 Years War or Dates Pt Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation Manner of Death©Natural Cause 0 Accident Homicide Suicide Undetermined Pending _4 Circumstances Investigation ric- fry; Medical Certifier Name Title Gwendolyn Morris-Dickinson PA Address 170 Warren St,Glens Falls,New York 12801 101, Death Certificate Filed District Number Register Number " City, Town or Village Glens Falls 5601 505 iBurial Date Cemetery or Crematory Li10/29/2018 Pine View Crematory ❑Entombment Address ®Cremation Queensbury Hamlet, New York Date Place Removed ❑Removal and/or Held and/or _, Address Hold Date Point of 4 1 Transportation _ Shipment by Common Destination Carrier _ Cs Q Disinterment Date Cemetery Address ofitF Date Cemetery Address []Renterment Permit Issued to Registration Number Name of Funeral Home Maynard D Bat, neral Huo a 01130 ry Address vi- 11 Lafayette St,Queensbury,New York 12804 ii Name of Funeral Firm Making Disposition or to Whom Z Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/29/2018 Registrar of Vital Statistics Rp6ert fi Curtis(Erectronicaffy Signed) la (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: pp^l J�j w, Date of Disposition to (3o jla Place of Disposition 1► i 1 -tor.., (address) (section) (lot numlor c (grave number) Name of Sexton or Person in harge of P mises ii t,)f, Jar'►4 (please print) F w• (2FAj, Signature /9a� Title (over) DOH-1555 (02/2004)