Reid, Mary NEW YORK'STATE DEPARTMENT OF HEALTH 2 ,a N Pt Z /
Vital Records Section Burial - Transit Permit
f Name First Middle Last Sex
,,, : Mary E. Reid Female
3iP- Date of Death Age If Veteran of U.S. Armed Forces,
January 16, 2011 80 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death v_xjNatural Cause ❑ Accident ❑ Homicide n Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
Medical Certifier Name Title
Christopher D. Hoy, M.D. Dr.
Address
102 Park St. Glens Falls, NY 12801
µ` Death Certificate Filed District Number Register Number
City, Town or Village 5 & 1 Z Li
0 Burial Date Cemetery or Crematory
January 18, 2011 Pine View Crematory
❑Entombment Address
I Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
I ❑ Disinterment Date Cemetery Address
❑ Reinterment Date Cemetery Address
% Permit Issued to Registration Number
be Name of Funeral Home M. B. Kilmer Funeral Home 01096
ic
lip Address
123 Main St., Argyle NY 12809
' Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
.< Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued t a i r f i 2o i 1 Registrar of Vital Statistics e rg\y�,
(signature
District Number J 60 1 Place 6 c . °i
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 01/18/2011 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) (lot numb ) (grave number)
Name of Sexton or Person in Charge Premises t r,,stop ` JehM
ii-
/7(1 (please print)
Signature C �^ Title Cf2F ih Mt
-
Title
(over)
DOH-1555 (02/2004)