Tucker, Linda NEW YORK STATE DEPARTMENT OF HEALTH
ir 35-
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Linda M. Tucker Female
Date of Death Age If Veteran of U.S. Armed Forces,
January 8, 2016 66 War or Dates
,iPlace of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death❑ Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
,11 Medical Certifier Name Title
Address
AO
Death Certificate Filed District Number 6 0 i Register Number
:. City, Town or Village Glens Falls tj
. ❑Burial Date Cemetery or Crematory
January 12, 2016 Pine View Crematory
❑Entombment Address
Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
and/or Address
Hold
Date Point of
; ❑Transportation Shipment
by Common Destination
Carrier
F Ill Disinterment Date Cemetery Address
IllReinterment Date Cemetery Address
T Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home-Argyle 01077
v % Address
123 Main St., Argyle NY 12809
Name of Funeral Firm Making Disposition or to Whom
- Remains are Shipped, If Other than Above
Address
n` Permission is hereby granted to dispose of the human remains described above as indicated.
M Date Issued 1 / t r J / i Registrar of Vital Statistics ., to
(signature)
District Number S 6 0/ Place
;` I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
'._ Date of Disposition 01/12/2016 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) (lot number) (grave number)
A.
g
Name of Sexton or Person in Charge of Premises Sinri
(please print)
Signature Title r= ""
(over)
DOH-1555 (02/2004)