Snowball, Rita NtW YUKK S I A I t UtF'AK I IVItw I or nc
Vital Records Section Burial - Transit Permit
Name First Mid Last Sex
Rita Ann Snowball Female
Date of Death Age U.S. Armed Forces,
February 28, 2016 78 War or Dates
°{ Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death El Natural Cause 0 Accident 0 Homicid Suicide 0 Undetermined Pending
Circumstances Investigation
Medical Certifier Name Tit'.
Dean Reali, Dr.
Address
Park Street Glens Falls, NY 12881
Death Certificate Filed District- umber Registe�,N�l er
X City, Town or Village Glens Falls P U
0 Burial Date Cemete
March 1, 2016 i Pine v - rematory
4 El Entombment Address
:-®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
Removal and/or Held
, , and/or Address
Hold
Date Point of
t.
0 Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
4,1 Name of Funeral Home M.B. Kilmer Funeral Home-SGF 01078
5 Address
136 Main Street, South Glens Falls NY 12803
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 re ains des ribed ab ve as indi••ted.
Date Issued Registrar of Vital Statistics e 7
k✓‘ /, '7 J „.„ ,.
(signature)
District Number Place ire? j, : -..
J
I certify that the remains of the decedent identified above were disposed of in accordance with thi permit on:
Date of Disposition 03/01/2016 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
4,1
(section) (lot number) (grave number)
Name of Sexton or Person in Charge o Premises r'' 11
S1•4
R (pl ase print)
,i
Signature Title farMtPit
(over)
DOH-1555(02/2004)