Trombley, Florence NEW YORK STATE DEPARTMENT OF HEALTH _ 41
Vital Records Section Burial - Transit Permit
Name First Middle Last
Florence Marie Trombley S Verna 1e
..../ ; i Date of Death Age If Veteran of U.S. Armed Forces,
2/5/15 90 War or Dates No
Place of Death Hospital, Institution or
City, Town or Village ArgyleJAIt Street Address 24 East Street, Argyle, NY
Manner of Death®Natural Cause 0Accident Homicide Suicide � Undetermined �Pending
Circumstances Investigation
ul Medical Certifier Names,,, ti ,,ed 4.474eviS Title
ini)clgrq s stufor U , 4.0a,cAtt4eS mi(ve5a
Death Certificate FBea District Number 30 Register Number
City, Town or Village Argyle L�
»`` E]Burial Date Cemetery or Crematory
2/6/15 Pine View Crematory
❑Entombment Address
Ellili OCremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Removal and/or Held
and/or Address
Hold
Date Point of
giQ Transportation Shipment
Es by Common Destination
Carrier
0ilil$ Disinterment Date Cemetery Address
iiii
Q Reinterment Date Cemetery Address
'<` Permit Issued to R6clietration Number
iiiiiiii Name of Funeral Home M.B. Kilmer Funeral Home
Viii Address
4. 123 Main St. Argyle, NY 12809
iiiiii Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address •
la
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 2/6/1 5 Registrar of Vital StatisticsL liti0,
(signature)
iiial District Number 5790 Place Village of Argyle, NY
ffil
iE
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2.,, �
Date of Disposition 2.MR(i s- Place of Disposition "l r-i14- ,
t (address)
Men (section) A (lot number) (grave number)
Name of Sexton or Person in Ch rge of Premises OA•s1� ,cum
2 j (ple_ase print)
Signature (�. Title tiAlcis
ri
(over)
DOH-1555 (02/2004)