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Hilton, Waltraud NEW YORK STATE DEPARTMENT OF HEALTH . t Vital Records Section Burial - Transitermit Name First Middle Last Sex Waltraud Anna Hilton Female Date of Death Age , If Veteran of U.S. Armed Forces, November 10, 2016 76 1 Gar or Dates Place of Death Hospital, Institution or w City, Town or Village Glens Falls Street Address Glens Falls Hospital CI Manner of Death 17T1xi Natural Cause ❑ Accident ❑ Homicide ❑ Suicide r7Undetermined ❑ Pending Circumstances Investigation WW, Medical Certifier Name Title Address Death Certificate Filed District Number �f l�� ll�Registe�ymb� City, Town or Village Glens Falls ❑Burial Date Cemetery or Crematory November 14, 2016 ❑Entombment Address ©Cremation Date Place Removed z Removal and/or Held O and/or Address F Hold Date Point of a. ❑Transportation Shipment 0 by Common Destination a Carrier ElDisinterment Date Cemetery Address IIIReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M. B. Kilmer Funeral Home- FE 01079 Address 82 Broadway, Fort Edward NY 12828 Name of Funeral Firm Making Disposition or to Whom $- Remains are Shipped, If Other than Above • Address W IL, Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued it//y 120 M Registrar of Vital Statistics (A) s W (signa ure) District Number 36o t' Place C (S)..S 1 \s u y I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: w Date of Disposition 11/14/2016 Place of Disposition 4?1U;t_ (rim cru (address) EC (section) i (lot number) (grave number) O Name of Sexton or Person in Charge of Premises C ''rAta.t Stint (please print) W Signature a Title (raf..ARV T (over) DOH-1555 (02/2004)