Felix, Carin NEW YORK STATE DEPARTMENT OF HEALTH13Z-
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Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Carin Felix Female
Date of Death Age If Veteran of U.S. Armed Forces,
7/2 9/1 1 81 _ War or Dates No
Place of Death Hospital, Institution or Argyle, NY
City, Town or Village Argyle Street Address PVI 4573 State Rt. 40
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▪ Manner of Death Natural Cause Accident D Homicide Suicide Undetermined Pending
Itt. Circumstances Investigation
til Medical Certifier Name Title
EDit Masaba MD
Address
1134 St. Rt. 29, Greenwich, NY
Death Certificate Filed District Number�� Register Number3 q
« City, Town or Village Argyle CD
❑Burial Date Cemetery or Crematory
❑Entombment 08/02/11 Pine View Crematory
Address
[ Cremation Quaker Road, Queensbury, NY
Date Place Removed
Z r7 Removal and/or Held
42 and/or
Address
t Hold
O Date Point of
Transportation Shipment
ES by Common Destination
iil Carrier
Disinterment Date Cemetery Address
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Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M.B. KIlmer Funeral Home 01 078-
RI Address
1b Main St. �- C`/ J /� 3
3 A,�g �e,.� nTvr� �?R� �// �� ��
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
a Address
at
t:
P"` Permission i9 reby granted to dispose of the human re ill/Is describedbo ' dicated.
Date Issued � i/ Registrar of Vital Statistics .� , ,off
(signature)
District Number 570 Place 7e)n 6 42-79y/...e._
s.« I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
PultOitiv I� 9-• Date of Disposition $-� %k Place of Disposition er t"..co r lLa�.
2 (address)
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to
Er i (section) (I t number) (grave number)
et Name of Sexton or P ..n in Charge o .remises it lot -71 L�"
z (ease print))
tii Signature ,r� ' Title Ci7Eiv` bTOQ—
(over)
DOH-1555 (02/2004)