Pike, Margaret NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit,
Name First Middle Last Sex
Margaret Elizabeth Pike Female
Date of Death Age If Veteran of U.S. Armed Forces,
8/18/2016 81 War or Dates No
Place 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
tW Circumstances Investigation
W Medical Certifier Name Title
Address
/OaArk_ Gr734f- Aii
Death Certificate Filed Di trict Number Re is tjer
City, Town or Village Glens Falls 5601 C
❑Burial Date Cemetery or Crematory
8/22/2016 Pine View Crematory
❑Entombment' Address
EtCremation Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
2 F and/or Address
N Hold
O Date Point of
NElTransportation Shipment
a by Common Destination
Carrier
El
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M.B. Klilmer Funeral Home 01 079
Address
82 Broadway, Fort Edward, NY 12828
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped, If Other than Above
2 Address
CC
W
a. Permission is hereby granted to dispose of the human remains de cribbed a ve inniicated.
Date Issued 8/2 2/2 01 6 Registrar of Vital Statistics
(signature)
District Number 5601 Place Glens Falls, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W• Date of Disposition g/23)/(f Place of Disposition pd,Q (J[
/ (adofess)
LU
t')
O (section) \\ /'(lot number) (grave number)
p Name of Sexton Person i Charge of Premises
Z (please print)
LLI Signature // Title G re,M i—
(over)
DOH-1555 (02/2004)