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Smith, Margaret NEW YORK STATE DEPARTMENT OF HEALTH $71/7 Vital Records Section Burial - Transit Permit Name Firrgaret Middle &h Se)emale D�te/2o /Q�ath Acre zu If Veteran of U.S. Armed Forces, 9 1 17 years War or Dates }- Place of Death Hospital, Institution or City, Town or Village Town Of Milton Street Address Gateway House Of Peace, 479 Rowland St Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ElUndetermined ❑Pending Ili Circumstances Investigation ILI Medical Certifier Name Title 0 Mark Hanson R.Physician Assistant Arlgrer Avenue, Corinth New York 12822 �h Cerown o�d Milton Dist 5cbt1Number R4e�ister Number , Town o i :❑Burial Date10/02/2017 Cei envy o wrCCrematori�um inev ❑Entombment Addr s '']Cremation ueensbury NY Date Place Removed Removal and/or Held �; and/or Address Hold 0 Date Point of f'Z` D Transportation Shipment Et by Common Destination Carrier Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Densmore Funeral Home Reois4�tion Number Name of Funeral Home AddreTsherman Avenue, Corinth Ny 12822 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above '„ Address iii '" Permission is hereby granted to dispose of the huma ins descri ed a ove as in ' to . Date Issued 09/29/2017 Registrar of Vital Statisti �* f $ l-JbQ� �� (signature) District Number 4561 Place Milton I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ILA Date of Disposition /D/Zill Place of Disposition f ,„ Of v".-- (address) lit I M (section) (lot number) (grave number) ,� �_ S Name of Sexton or Person in Charge of Premis 1 01. lit '"Z' QJ (ple se print) Iii Signature "( h� Title C� �� (over) DOH-1555 (02/2004)