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Constantineau, Cheryl NEW YORK STATE DEPARTMENT OF HEALTH 4ffifir --71 Vital Records Section t "Nit Burial - Transit Permit Name First Middle Last Sex Cheryl Lynn Constantineau Female Date of Death Age If Veteran of U.S. Armed Forces, February 10, 2011 51 War or Dates Place of Death Hospital, Institution or inCity, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death a Natural Cause ❑ Accident n Homicide ❑ Suicide n Undetermined ❑ Pending U Circumstances Investigation W Medical Certifier Name Title Paul F. Bachman, Address 3767 Main Street Warrensburg, NY 12885 Death Certificate Filed District Number r Register Number City, Town or Village J 6© I -7 ( ❑ Burial Date Cemetery or Crematory February 16, 2011 Pine View Crematory ❑ Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z ❑ Removal and/or Held a and/or Address H Hold O Date Point of nTransportation Shipment O by Common Destination Q' Carrier Date Cemetery Address n Disinterment Date Cemetery Address El Reinterment Permit Issued to Registration Number Name of Funeral Home M. B. Kilmer Funeral Home 01098 Address 82 Broadway, Fort Edward NY 12828 Name of Funeral Firm Making Disposition or to Whom I— Remains are Shipped, If Other than Above • Address te ILf flt..' Permission is hereby granted to dispose of the human remains described above as)indicated. Date Issued 2./i `-1 / t r Registrar of Vital Statistics LA) .L,',,/1�.CV (signature District Number 5 ho, Place 6 iA"-S \\5 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: w. Date of Disposition 02/16/2011 Place of Disposition Quaker Road Queensbury,NY 12804 (address) LLI re (section) / + (lot num gr) (grave number) 0 Name of Sexton or Per n in Charge of remises L t•s{�h.rttl (please print) g Ui Signature Title ( Zet9}tda.. .�, (over) DOH-1555 (02/2004)