Pashby, Isabelle t 58,E
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Isabelle Pashby Female
Date of Death I Age If Veteran of U.S.Armed Forces,
8/15/2016 186 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 El Accident 0 Homicide ®Suicide p Undetermined ❑Pending
Circumstances Investigation
la Medical Certifier Name Title
Q, Michael Miles
Address
100 Park Street 12801
,DeatkCertificate Filed District Number
J n\ Reg !Amber
own or Village (2nS'�d l ‘OBurial Date Cemetery or Crematory
8/16/2016 Pine View Crematory'
❑Entombment' Address
ElCremation 21 Quaker Road, Queensbury,NY 12804
Date Place Removed
ri Removal and/or Held
and/or
Hold Address
Date Point of
1 El Transportation ( Shipment
by Common + Destination
Carrier
Disinterment Date Cemetery Address
0 Renterment r Date Cemetery Address
Permit Issued to 1 Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home 101078
Address
136 Main Street, South Glens Falls,NY 12803
Name of Funeral Firm Making Disposition or to Whom
h Remains are Shipped, If Other than Above
a Address
CC
iii
°` Permission is hereby granted to dispose of the hums remains escxibid above as I I
Date Issued d'l'(alapji;., Registrar of Vital Statistics
( (sue)
District Number ���/ Place A
,z,
,_ I certify that the remains of the decedent identified above were disposed of in a ordance/ with this permit on:
Date of Disposition ' l i t f/b Place of Disposition go qt.. (r crs(1,
(address)
(section) I (kg number) (grave number)
Name of Sexton or Person in Char a of Premises I1 ( St
X (pleas*pnnf)
Signature Title L1l)Wt4 VIt
(over)
00141555 (02/2004)