Archer, Megan NEW YORK STATE DEPARTMENT OF HEALTH . *
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Megan Jane Archer female
Date of Death Age If Veteran of U.S.Armed Forces,
08/06/2011 19 War or Dates
}- Place of Death Hospital, Institution or
Z City Town eicltitlagex Greenwich Street Address County Route 52
a Manner of Death Natural Cause ®Accident 0 Homicide 0 Suicide El Undetermined Pending
114 Circumstances Investigation
in Medical Certifier Name Title
II Edward S. Parsons III Coroner
Address
17 Prospect St. , Granville, NY 12832
Death Certificate Filed District Number Register Number
cam, Town athiiiidgEk Greenwich 5157 3
0Burial Date Cemetery or Crematory
08/09/2011 Pine View Crematory
❑Entombment Address
. (Cremation Queensbury, NY
Date Place Removed
Z❑Removal and/or Held
2 and/or Address
F= Hold
#)
Date Point of
Q Transportation Shipment •
a by Common Destination
Carrier
El Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Ei! Permit Issued to Registration Number
Name of Funeral Home Flynn Bros. , Inc. 00588
Address
13 Gates Ave. , Schuylerville, NY 12871
Name of Funeral Firm Making Disposition or to Whom
l- Remains are Shipped, If Other than Above
,2 Address
tr.
in
A. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued Siff" li Registrar of Vital Statistics 'C _ A
DLJar
(signature
District Number .s-is-1 Place G x-wL.-i-- IL) "(
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2
l Date of Disposition 1?- -it Place of Disposition Eiivu lyEih► avegfe''t��'
2 (address)
111
In
CC (section) (lot number (grave number)
0 Name of Sexton or Per n in Charge o remises ��5 ✓ ,,,tti-
>l3
I (Please print)
Signature Title CQt'z M1 t OIL
(over)
DOH-1555 (02/2004)