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O'Sick, Gloria tt NEW YORK STATE DEPARTMENT OF HEALTH Z' Vital Records Section Burial - Transit Permit q Name First Middle Last Sex 1;1 Gloria O'Sick Female °� D• ate of Death Age If Veteran of U.S. Armed Forces, 11 January 19, 2016 88 War or Dates E"'' P• lace of Death Hospital, Institution or City, Town or Village Argyle Street Address Washington Center 8.,: Manner of Death Natural Cause ❑ Accident ❑ Homicide ❑ Suicide 0 Undetermined ❑ Pending Circumstances Investigation itt Medical Certifier , Name ^�,� +, Title0 Adelre8s --` ^ 1 Q) • Death Certificate Filed District Numbed Register Number j = City, Town or Village Argyle S7 5 4 G IA ❑Burial Date Cemetery or Crematory " January 2,2016 Pine View Crematory 0 Entombment Address • ©Cremation Quaker Road Queensbury,NY 12804 ❑ Removal Date Place Removed and/or Held ,.0., and/or Address Hold RI Date Point of ❑Transportation Shipment . by Common Destination Carrier } ❑ Disinterment Date Cemetery Address xr Date Cemete Address rY ❑ Renterment Permit Issued to Registration Number • Name of Funeral Home M. B. Kilmer Funeral Home- FE 01079 Address 82 Broadway, Fort Edward NY 12828 d; g Name of Funeral Firm Making Disposition or to Whom y Remains are Shipped, If Other than Above Address 1771 Permission is hereby granted to dispose of the human re ins described above as indicated. '` Date Issued i/D 6' J '0 Registrar of Vital Statistics ` K..e,u�,,r, (signature) District Number 535.6 Placele. ?UV I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: u Date of Disposition 01/21/2016 Place of Disposition Quaker Road Queensbury,NY 12804 (address) (section) (lot number) //��// (grave number) ' Name of Sexton or Person in Charge of Premises G�r,4df mot (pl-ease print) Signature U. Title aZron ii, (over) DOH-1555 (02/2004)