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Harris, Margaret NEW YORK STATE DEPARTMENT OF HEALTH `t Vital Records Section • N. Burial - Transit Permit Name First Middle Last Sex Margaret Elizabeth Harris Female Date of Death Age If Veteran of U.S. Armed Forces, May 9, 2011 85 War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Deathrn j Natural Cause Accident El Homicide El Suicide Undetermined ] Pending Circumstances Investigation Medical Certifier Name Title Matthew Varughese, M.D. Dr. Address 100 Park Street Glens Falls, NY 12801 Death Certificate Filed District Number ,�7 _a r Register City, Town or Village .JtOLO ❑Burial Date Cemetery or Crematory May 11, 2011 Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Removal Date Place Removed El and/or and/or Held Hold Address Date Point of Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00276 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is egranted to dispose of the human remains Izccrib aI�pe as n i ated. Date Issued 4 !Z49C/ Registrar of Vital Statistics (signature) District Number jT(oo/ Place e 74 /7 7/5 /(`y I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition f't3-t'i Place of Disposition e� 644or« (address) (section) !(lot numbeer (grave number) Name of Sexton or 4I (please 47U son in Char of Premises r•, k t" �C 44$ print) Signature C Title 6OUY2 (over) DOH-1555(02/2004)