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Garrity, Constance NEW YORK STATE DEPARTMENT OF HEALTH f7 1cj Vital Records Section Burial - Transit Permit Name First Middle Last Sex Constance Garrity Female Date of Death Age If Veteran of U.S. Armed Forces, October 19, 2016 101 War or Dates Place of Death Hospital, Institution or City, Town or Village Street Address Home of the Good Shepherd Manner of Death a Natural Cause EI Accident 0 Homicide 0 Suicide EiUndetermined ri Pending Circumstances Investigation J f Medical Certifier Name Title \ (� �t Brigitte Bekan-Homawoo, / t !J Address 15 Maple Dell Saratoga Springs, NY 12866 De-th Certificate File District Number Register JV r er OP Townor Village 51 50 [1 �L- Date tilaS Cemete or Crematory ■ Burial October 21, 2016 Pine View Crematory .- ,❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z Removal and/or Held and/or Address E Hold Oh Date Point of a ❑Transportation Shipment by Common Destination Cf Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M.B. Kilmer Funeral Home-SGF 01078 Address 136 Main Street, South Glens Falls NY 12803 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address i3 P:::: is he by�� 7ted to dispose of the human remains §crib t_fiove a i i ated. � Re istrar of Vital Statistics � 9� (signature) District Number Li 601 PlaceSAQA-pci,,A, 9Q-1 A3n_3 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: w Date of Disposition 10/21/2016 Place of Disposition Quaker Road Queensbury,NY 12804 (address) in C (section) /��� (lot number) (grave number) d Name of Sexton or Person in Charge of Premises /4,4 ( Sig ift/ � � � please print) Signature Title (00m i)g- (over) DOH-1555 (02/2004)