Kehrer, Ethel NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
• Name First Middle Last Sex
Ethel A. Kehrer Female
:_: Date of Death Age If Veteran of U.S. Armed Forces,
July 31,2011 99 War or Dates
`:, Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of DeathLiit. Natural Cause ❑Accident ❑Homicide E Suicide Ti Undetermined n Pending
Circumstances Investigation
g Medical Certific• Fame Title
P. r .{A \I t 11 1,,E �D
Adoress '
(,ee\S 1
Death Certificate Filed ` �� District Number Ret4r Number
City, Town or Village Glens Falls,NY 5601 91
❑Burial Date Cemetery or Crematory
D
Entombment August 2,2011 Pine View Crematory
Address
®Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
z C Removal and/or Held
and/or Address
1"- Hold
to
O Date Point of
s I I Transportation Shipment
p by Common Destination
_ Carrier
Ti Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
4„: Permit Issued to Registration Number
:.: Name of Funeral Home Sullivan Minahan& Potter I 01646
• Address
:: 407 Bay Road, Queensbury, NY 12804
_: Name of Funeral Firm Making Disposition or to Whom
t• Remains are Shipped, If Other than Above
Address
Permission is here y granted to dispose of the human remains d Vd a ve n icated.
Date Issued Dg 03 a9// Registrar of Vital Statistics ' s
:, (signature)
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
UJ Date of Disposition 4-t(-II Place of Disposition ,ru Ulu am/tot+�
(address)
W
(I)
OC (section) (lot num ) (grave number)
8 Name of Sexton or Person in Charge of Premises
146%4%444r Arc(t
Z I (please print)
W Signature t�* Title �Rv144t'c02,
(over)
DOH-1555(02/2004)