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Minshall, Minnie NEW YORK STATE DEPARTMENT OF HEALTH IF • • v j 77.77 Vital Records Section Burial - ransit Permit Name First Middle Last Sex Minnie Eva Minshall Female Date of Death Age If Veteran of U.S. Armed Forces, October 23, 2016 94 War or Dates Place of Death Hospital, Institution or Lai" City, Town or Village Argyle Street Address Washington Center Manner of Death .i Natural Cause ❑ Accident E Homicide ❑ Suicide ❑ Undetermined ❑ Pending lilCircumstances Investigation Medical Certifier Name Title Edit Masaba, MD Dr. Address 35 Gilbert Street Greenwich, NY 12834 Death Certificate Filed District Number S o Register Number City, Town or Village Argyle1-4y ❑Burial Date Cemetery or Crematory October 24, 2016 Pine View Crematory 0 Entombment Address ,r ©Cremation Quaker Road Queensbury,NY 12804 '4 Date Place Removed ❑ Removal and/or Held and/or Address Hold Date Point of t_❑Transportation Shipment by Common Destination 0 Carrier Date Cemetery Address El Disinterment • ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M. B. Kilmer Funeral Home-Argyle 01077 Address 123 Main St., Argyle NY 12809 �, Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human rem 'ns described above as indicated. Date Issued /0- 01/44-A. Registrar of Vital Statistics 3,., (signature) District NumberS-1s Ls Place 1 9 t Ai I'24' I I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: i Date of Disposition 10/24/2016 Place of Disposition Quaker Road Queensbury,NY 12804 (address) g (section) l (lot number) (grave number) Name of Sexton or Person in Charge of Premises,�/ t�nc+pi- please print)Slwwa(d Signature �-f �� Title ( "►+ iD (over) DOH-1555 (02/2004)