Ward, Doris NEW YORK STATE DEPARTMENT OF HEALTH ` 1. 37
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Doris G. Ward Female
Date of Death Age If Veteran of U.S. Armed Forces,
January 10, 2015 100 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Argyle Street Address Washington Center
Manner of Death El Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ri❑ Pending
Circumstances Investigation
Medical Certifier Name Title
Pamela Casey,
, Address
Death Certificate Filed District Number Register Number
City, Town or Village Argyle S`�7So 3
❑Burial Date t'i, (i 1 Cemetery or Crematory
Pine View Crematory
5 �i
ti 0 Entombment Address
,1„.. to., Quaker Road Queensbury,NY 12804
' Date Place Removed
❑
Removal and/or Held
and/or
Hold Address
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
ry, ❑ Disinterment Date Cemetery Address
ElReinterment Date Cemetery Address
Permit Issued to
Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home 01077
Address
.' 123 Main St., Argyle NY 12809
-,y Name of Funeral Firm Making Disposition or to Whom
- Remains are Shipped, If Other than Above
f Address
Permission is hereby granted to dispose of the human remains described above as indicated.
g atilt" c .w✓
Date Issued fll31 IS Registrar of Vital Statistics
J (signature)
District Number gist Place Q/ I�yk i 11,
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition I/i b/L5' Place of Disposition Quaker Road Queensbury,NY 12804
(address)
>.; (section) 4 (lot number) (grave number)
Name of Sexton or Perso in Charge of Premises L hriff ," 1211 4"
/ (please print)
Signature l� Title CRitorlg .
(over)
DOH-1555 (02/2004)