Hill, Margaret NEW YORK STATE DEPARTMENT OF HEALTH r �1 . C $
Vital Records Section i Burial - Transit Permit
Name First Middle Last Sex
Margaret Susanne Hill Female
VA
A,,, Date of Death,_ Age If Veteran of U.S.Armed Forces,
09/23/2016 63 War or Dates
Place of Death Hospital, Institution or
t City, Town or Village Glens Falls Street Address Glens Falls Hospital
6 i Manner of Death Natural Cause ❑ Accident ❑Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
Medical Certifier Name Title
Charles Yun, MD,
Address
J 3'i, 102 Park Street Glens Falls, NY 12801
A Death Certificate Filed District Number W� 1 Regiist r�lu�mber
,,t City, Town or Village LI
R❑Burial Date �,or Crema,t9 ry
09/26/2016 iff',.7 ri/-E .; Kor2e.,
I❑Entombment
Address
t ®Cremation s/-e� li(r1j 4A _ i/7 � d'`�
Date / Place Removed
• y❑ Removal and/or Held
and/or Address
Hold
'" Date Point of
,' ❑Transportation Shipment
' ;z by Common Destination
Carrier
❑ Date Cemetery Address
Disinterment
❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
r,, Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00141
"' Address
9 Pine St/P.O. Box 455 Chestertown NY 12817
• .k Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby ranted to dispose of the human r- .•_.ins d :cribed ab• e as indi•ated.
Date Issued 0 Registrar of Vital Statistics ,Af/ �... `/ L �//,t
( 'gnature)
IS
1 District Number yp / Place 4 ��_4
per, ��-
h
- I certify that the remains of the decedent identified above were disposed of inaccordannc= ith this permit on:
' ', Date of Disposition 7 I L71/6 Place of Disposition Za VI 4.4 atrf /'10r.,
(address)
(section) /� (lot number) c - (grave number)
Name of Sexton or Person in Charg of Premises !. ,rl k r Jt N ic6�-
/ ( lease print)
Signature 6 t 441Title aziem4
(over)
DOH-1555(02/2004)