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Waters, Louise NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit ti Name First Middle Last Sex Louise L. Waters Female Date of Death Age If Veteran of U.S. Armed Forces,� March 21, 2015 68 War or Dates Place of Death Hospital, Institution or City, Town or Village Argyle Street Address Washington Center Manner of Death a Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined n Pending ;� Circumstances Investigation Medical Certifier Name •i 1. [y)4$ qb4 Titl `/ = Address G_ / Death Certificate Filed District Number S d ' Register Number City, Town or Village Argyle -57 ❑Burial Date Cemetery or Crematory March 25, 2015 Pine View Crematory ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed ❑ 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 Funeral Home-Argyle 01077 Address 123 Main St.,Argyle NY 12809 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address 4,e Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued *31 is- Registrar of Vital Statistics (signature) District Number Si St, Place y(-C �=3 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 03/25/2015 Place of Disposition Quaker Road Queensbury,NY 12804 (address) w ; (section) (lot number), (grave number) Name of Sexton or Person in Charge of Premises ri (p ase print) Signature Title 40 4111114 (over) DOH-1555 (02/2004)