Light, Darlene NEW YORK STATE DEPARTMENT OF HEALTH } - i
Vital Records Section Burial - Transit Permit
777
�, R
Name First Middle Last Sex
Darlene I. Light Female
Date of Death Age If Veteran of U.S. Armed Forces,
January 9, 2016 68 War or Dates
Place of Death Hospital, Institution or
• City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined r-i❑ Pending
Circumstances Investigation
• : Medical Certifier Name Title
Mathew Varughese, M.D. Dr.
, Address
100 Park Street Glens Falls, NY 12801
a Death Certificate Filed District Number Register Nu ber
n City, Town or Village Glens Falls
to 0 Burial Date Cemetery or Crematory
January 11, 2016 Pine View Crematory
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
and/or Address
''m Hold
Date Point of
-, ❑Transportation Shipment
by Common Destination
Carrier
t� Date Cemetery Address
4 El Disinterment
x
❑ Reinterment Date Cemetery Address
41
Permit Issued to 9
Re istration Number
in Name of Funeral Home M. B. Kilmer Funeral Home-FE 01079
Address
_1,` 82 Broadway, Fort Edward NY 12828
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereb granted to dispose of the human remains described a ve asd indic ted.
ii Date Issued(�( Registrar of Vital Statistics �f(,P� b�\�// �?--r-
(signature)
, 4District Number Place c��'� e �G �' "�� �
J
I certify that the remains of the decedent identified above were disposed of in accorda ce with this permit on:
x Date of Disposition 01/11/2016 Place of Disposition Quaker Road Queensbury,NY 128041,4/e
(address)
(section) f lot number) c (grave number)
Name of Sexton or Person in Ch ge of Premises risib ..JCyoy�
(ple se print)
„,„i Signature d
Title ( biPV
(over)
DOH-1555 (02/2004)