Higgins, Margaret NEW YORK STATE DEPARTMENT OF HEALTH ! 4 # 5 w
Vital Records Section Burial - Transit Pe mit
Name First Middle Last Sex
Margaret Cecelia Higgins Female
Date of Death Age If Veteran of U.S. Armed Forces,
October 8, 2012 88 War or Dates
I-- Place of Death Hospital, Institution or
'w
W City, Town or Village Glens Falls Street Address Glens Falls Hospital
WManner of Death 0 Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
U Circumstances Investigation
W Medical Certifier Name Title
Cli Christopher Hoy MD,
Address
Suite C Glens Falls, NY 12801
Death Certificate Filed //'� District Number Register N mber
City, Town or Village (,9l-!i,S ;iJ 1/45-601 Vb I
0 Burial Date Cemetery or Crematory
October 12, 2012 Pine View Crematorium
❑Entombment Address
❑Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ❑ Removal and/or Held
and/or Address
r: Hold
0' Date Point of
IL ❑Transportation Shipment
) by Common Destination
CI Carrier
Date Cemetery Address
El Disinterment
Date Cemetery Address
❑ Reinterment
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped, If Other than Above
2 Address
IX
LEI
a. Permission is he eeb granted to dispose of the human remains d cribed abo e as Indic. ed.
Date Issued % jp j� Registrar of Vital Statistics � '® / `
(signature)
District Number S60% Place 6/e/75 laps; by 1o1g` i
HI certify that the remains of the decedent identified above wer disposed of in accordance with this permit on:
LZ Date of Disposition tojit hi Place of Disposition .`4Olt� C,rnK/tOrtiii•
2 (address)
W
CO
CC (section) - (lot number) ((�� (grave number)
0 Name of Sexton or Pe son in Charge f Premises I
tsi f Cl-A-
Z
(please print)
W Signature Title (tr ftl pi rot
(over)
DOH-1555 (02/2004)
Town of Queensbury
Certification of Cremation
V g Pine View Cemetery and Crematory
This certifies that the remains of: Margaret Higgins
were cremated on October 16 20 12 at the Pine View
(Month) (Day)
Crematorium, Queensbury,New York, and these are the cremated remains of said body.
Date of Death October , 8 20 12 Age 88
(Month) (Day)
Funeral Home Carleton Registered No. 541
(Authorized 4
gnature) i- • 6b/90 14 reg
(lie j14 EC/Wail
6U1 6 ed a , ma s Ce me* ,
on a 5cc-n6 6(ia . , G '