McMurry, Sandra f I
NEW YORK STATE DEPARTMENT OF HEALTH 2
Vital Records Section Burial - Transit Permit
Name First Middle Last ` Sex
Sandra McMurry Female
Date of Death ' Age If Veteran of U.S.Armed Forces,
9/4/2016 i 77 War or Dates No -
Place of Death Hospital. Institution or
City, Town or Village Glens Falls ! Street Address Glens Falls Hospital
Manner of Death i_J Natural Cause []Accident 0 Homicide El Suicide ❑Undetermined ❑Pending
Circumstances Investigation
1 Medical Certifier Name Title
C3 Marvin Davidowitz MD
Address
Glens Falls Hospital 12801
Death Certificate Filed District Number Regis
City,Town or Village Glens Falls �'�&1
tepygber
OBurial Date Cemetery or Crematory
9/6/2016 Pine View Crematory
❑Entombment Address
OCremation 21 Quaker Road,Queensbury New York 12804
Date Place Removed
rl Removal and/or Held
and/or
Hold Address
} Date Point of
&Q Transportation Shipment
O by Common ' Destination
Carrier
0 Disinterment Date Cemetery Address
ID
Reinterment Date Cemetery Address
Permit Issued to F Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home 01079
Address
82 Broadway, Fort Edward,New York 12828
Name of Funeral Firm Making Disposition or to Whom
h Remains are Shipped, If Other than Above
Z Address
CC
to
a'' Permission is hereby granted to dispose of the human remains described above as Indicated.
Date Issued C) / b) 1 6 Registrar of Vital Statistics ( J c -)— CA).A414
(srgrreture)
District Number 5 6 1 Place 6 ��S t'�- , `\s 1 x,ry
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
i Date of Disposition //7r/b Place of Disposition ��tv`'`l
(address) --
( chon) lot number) (grave number)
I Name of Sexton or Person in Charge of Premises Ji
( 4s+Rnnt) dd
4414-
Wg
Signature Title M,,'
(over)
DOH-1555 (02/2004)