Whaley, Linda " • 1 i 6-$1
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First _ Middle Last Sex
Linda R. Whaley Felame
Date of Death Age If Veteran of U.S. Armed Forces,
8/9/1 5 5 3 War or Dates No
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death®Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
UJ Circumstances Investigation
ill Medical Certifier Srat, e
V i1 A� c 0
loc__ g..._, G t `
172Q)1:),i,
Death Certificat�Filed District Number Regis mber
City, Town or Village Glens Falls 5601
❑Burial Date Cemetery or Crematory
8/10/15 Pine View Crematory
❑Entombment Address
['Cremation QuakerRoad, Queensbury, NY
Date Place Removed
Z ri❑Removal and/or Held
and/or Address
Hold
Q Date Point of
0 Li Transportation Shipment
0 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 01 079
Address
82 Broadway, Fort Edward, NY 12828
Name of Funeral Firm Making Disposition or to Whom
li Remains are Shipped, If Other than Above
2 Address
iti
Permission is hereby granted to dispose of the human remains described abo as i i ated.
Date Issued 8/1 0/1 5 Registrar of Vital Statistics described his✓ '
(signature)
District Number 5601 Place City of Glens Falls, NY
certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
1
#Li Date of Disposition g fit I)- Place of Disposition fiotfd.J Crr,.r
(address)
LEI
tO
LE (section) A (lot number) (grave number)
ci Name of Sexton or Person in Charge of Premises r%'+`"� °"'
Z (p/ ase print)
Signature Title g.
(over)
DOH-1555 (02/2004)