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Voordeckers, Maria , . . "+ it763 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex . Maria Jeanne Voordeckers Female .Y Date of Death Age If Veteran of U.S. Armed Forces, October 26, 2016 95 War or Dates `". Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death 0 Natural Cause Accident Homicide Suicide 0 Undetermined Pending Circumstances Investigation Medical Certifier Name Title Wendy Steinhacker, Address 100 Park Street Glens Falls, NY 12801 Death Certificate Filed District Number / ' Register N mb City, Town or Village Glens Falls D O Q ( 1 5 -I ❑Burial Date Cemetery or Crematory October 27, 2016 Pine View Crematory 0 Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed 1-1 Removal and/or Held 0 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 Name of Funeral Home M.B. Kilmer Funeral Home-SGF 01078 Address 136 Main Street, South Glens Falls NY 12803 Name of Funeral Firm Making Disposition or to Whom iRemains are Shipped, If Other than Above Address ill CL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued j C)( '//6 Registrar of Vital Statistics r O -\,R, �,t w b+ (signatur District Number J 6j�1 Place (&,", Eck `As,ik.)-L? I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 10/27/2016 Place of Disposition Quaker Road Queensbury,NY 12804 (address) (section) (lot number (grave number) Name of Sexton or Person in Charge o Premises 1h411 (please print) Signature 4 Title CO- krOg (over) DOH-1555 (02/2004)