Gilman, Gertrude 14
NEW YORK STATE DEPARTMENT OF HEALTH I 7.-
Vital Records Section go'', isBurial - Transit Permit
= Name First Middle Last Sex
Gertrude N Gilman Female
Date of Death Age If Veteran of U.S. Armed Forces,
t,",; June 24, 2011 92 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
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Manner of Death El Natural Cause ❑ Accident ❑Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
t Medical Certifier Name Title
Marvin Davidowitz, Dr.
wot Address
Glens Falls Hopital Glens Falls, NY 12801
Death Certificate Filed District in ber Reginttirn er
City, Town or Village
got❑Burial Date Cemetery or Crema ory
, 3
❑Entombment Address
'?0 Cremation
Date Place Removed
,- ❑ Removal and/or Held
and/or Hold Address
-i Date Point of
❑Transportation Shipment
by Common Destination
Carrier
ot ❑ Disinterment
Date Cemetery Address
tii-
gg 0 Reinterment Date Cemetery Address
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nt} Permit Issued to Registration Number
, Name of Funeral Home M. B. Kilmer Funeral Home 01098
Address
�_ 82 Broadway, Fort Edward NY 12828
go�.
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
44 Permission is her by ranted to dispose of the human(emains scribed above as indi ated.
Date Issued Registrar of Vital Statistics
-7 aik.--e______
�, sign'Ure)
-vvA District Number Place ,,_ L j
7 6
I certify that the remains of the decedent identified above were disposed of in accordance with is permit on:
Date of Disposition G-t'-tl Place of Disposition g„JVm Cwv,gtr4ti.
(address)
(section) ,(lot num (grave number)
Name of Sexton or P r on in Charge f Premises X 15Y4 r 41
(please print)
gog Signature ., Title Cekihkloe_
(over)
DOH-1555 (02/2004) •