VanBuren, Maureen NEW YORK STATE DEPARTMENT OF HEALTH "`' 2-6'
Vital Records Section I " ` Burial - Transit Permit
Name First Middle Last Sex
Maureen Anita VanBuren Female
Date of Death Age If Veteran of U.S. Armed Forces,
March 22, 2015 54 War or Dates
Opp-ce of Death - . �( Hospital, Institution or
�,Y Town or Village �V Street Address The Capital Living Nursing & Rehabilitation
ner of DeathIf] Natural Cause IIIAccident ElHomicide ❑ Suicide Undetermined ❑ Pending
Circumstances Investigation
Medical Certifier N�r�ie�I �/ , , fl �}
Address
eJCertificate Filed St
District Number O/ Register Nu erc
, Town or Village "6
r ■ Burial Date Cemetery or Crematory
March 24, 2015 Pine View Crematory
❑Entombment Address
" ®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
2 ❑ Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
❑ Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funer4 H!°rne- F'E' 0 0107?j
t' Address /No, (i1Af1N So.. Gteivs J-—L 6S r A vf-c iltbo
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
a s
Permission is hereby ranted to dispose of the human remain escr' ed ab .as iindica
Date Issued 5 Registrar of Vital St istics kji L i-
District Number 1/(20 / Place Jail (signature)
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 03/24/2015 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) (lo number) (grave number)
Name of SextonJP9Charen g of Premises CI(pie a print) /
Signature /4<)1- Title Cre-,e34/19-PZ r T .
(over)
DOH-1555 (02/2004)