Perkett, Paula NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Paula Perkett Female
g. Date of Death Age If Veteran of U.S. Armed Forces,
March 19, 2015 83 War or Dates
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
Circumstances Investigation
Medical Certifier Name Title
Paul F. Bachman,
Address
k 3767 Main Street Warrensburg, NY 12885
Death Certificate Filed District Number 5 r 6o� ) Register Number
City, Town or Village Glens Falls
,_❑Burial Date Cemetery or Crematory
March 23, 2015 Pine View Crematory
0 Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
it Date Place Removed
':❑ Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
Ze ❑ Disinterment
Date Cemetery Address
4 III Reinterment Date Cemetery Address
Permit Issued to Registration Number
Aitt Name of Funeral Home M.B. Kilmer Funeral Home-SGF 01078
alei°° Address
g 136 Main Street, South Glens Falls NY 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
f ,s Permission is hereby granted to dispose of the human remains described above as indicated.
T
Date Issued 3/Z3 w l (5 Registrar of Vital Statistics t c L `
Z (signature)
District Number 56'0. ( Place 6 (Q 5 c 1 k 5 i
itss I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 03/23/2015 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises
(please print)
Signature Title
(over)
DOH-1555 (02/2004)