Aston, Lucille NEW YORK STATE DEPARTMENT hF HEALTH 11
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Lucille C.Aston Female
'',> Date of Death Age If Veteran of U.S. Armed Forces,
05/31/2018 101 Years War or Dates
1.0 Place of Death Hospital, Institution or
City, Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare
Manner of Death J Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
ALICircumstances Investigation
Medical Certifier Name Title
Ct Jennifer Hayes MD
Address
4573 State Route 40,Argyle Town,New York 12809
Death Certificate Filed District Number Register Number
City, Town or Village Argyle 5750 18
❑Burial Date Cemetery or Crematory
06/04/2018 Pine View Crematory
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
L ❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
• ❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
N Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079
` Address
82 Broadway,Fort Edward,New York 12828
• Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
+ s
,: Permission is hereby granted to dispose of the human remains described above as indicated.
%, Date Issued 06/04/2018 Registrar of Vital Statistics Shefleyey Mckenwn(Ef.ectronicallySigned)
(signature)
District Number 5750 Place Argyle, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition L/Sjig Place of Disposition P,F,11.-/ erv-ia-.
(address)
(section) get number) (grave number)
•
Name of Sexton or Person in Charge of Premises "41 i
(pieap print)
• Signature a e Title (1)f TU1.
(over)
DOH-1555(02/2004)