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Conklin, Lillian . . 31( NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Lillian M. Conklin Female Date of Death Age If Veteran of U.S. Armed Forces, May 24,2016 95 War or Dates Place of Death Hospital, Institutiortirondack Tri-County Health Care Z City, Town or Village Johnsburg Street Address Center 41 Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation wy Medical Certifier Name Title Thomas Warrington Address HIHIN,Johnsburg,NY 12843 Death Certificate Filed District Number Register Number City, Town or Village 5655 ! ❑Burial Date Cemetery or Crematory Entombment May 25,2016 Pine View Crematory Address ©Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed Z Removal and/or Held and/or Address Hold CO O Date Point of N Transportation Shipment a by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander-Baker Funeral Home 00037 Address 3809 Main Street,Warrensburg,NY 12885 Name of Funeral Firm Making Disposition or to Whom 1 Remains are Shipped, If Other than Above • Address 11. Permission is hereby granted to dispose of the human rem• descri d a ve as in ' ated. Date Issued -.51-(95 .p Registrar of Vital Statistics a ure) District Number Sip Place 4 certify that the remains of the decedent identified above were disposed of in accordan a with this permit on: p W• Date of Disposition S/ZLig, Place of Disposition f U 1 L 4 W (address) N CC (section) -(lot,number (grave number) Q Name of Sexton or Person in Charge of Premises ter �t►• ' Z ( lease print) W Signature / Title Crt)01-TVK- (over) DOH-1555 (02/2004)