Mackerracher, Elizabeth NEW YORK STATE DEPARTMENOF HEALTH
f7 d 1.
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Elizabeth Mackerracher Female
Date of Death Age If Veteran of U.S. Armed Forces,
11/21/2017 90 Years War or Dates
- Place of Death Hospital, Institution or
City, Town or Village Albany Street Address Albany Medical Center Hospital
Manner of Death X❑Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Matthew Anderson MD
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City, Town or Village Albany 0101 2548
OBurial Date Cemetery or Crematory 11/24/2017 Pine View Crematory
❑Entombment
Address
®Cremation Queensbury Town, New York
Date Place Removed
Removal and/or Held
and/or Address
Hold
Date Point of
Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/21/2017 Registrar of Vital Statistics Daniefk sGilfespie E(ectronicaaySigned.
(signature)
District Number 0101 Place Albany, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 1/1211 n Place of Disposition �►,'x ✓ g4(cat
(address)
(section) , (lot number) (grave number)
Name of Sexton or Person in Charge of remises L%,.i+ l— 3.l4 itt
1 (p se print)
Signature tof-' Title (e6,19 W
(over)
DOH-1555 (02/2004)