Linehan, Luella NEW YORK STATE DEPARTMENT OF HEALTH , , 7///c
Vital Records Section
'� Burial - Transit Permit
Name First Middle Last Sex
5 Luella Christine Linehan Female
Date of Death Age If Veteran of U.S. Armed Forces,
February 19, 2015 86 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address The Stanton Nusing and Rehabilitation
Manner of Death 0 Natural Cause 111 Accident 0 Homicide El Suicide n Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Suzanne Blood, Dr.
Address
161 Carey Road Queensbury, NY 12804
Death Certificate Filed District Number ' Reajster Number
�
City, Town or Village Queensbury 5j
0 Burial Date Cemetery or Crematory
February 23, 2015 Pine View Crematory
�,g❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
::,,,,A, Date Place Removed
,r1 Removal and/or Held
and/or Address
Hold
Date Point of
4❑Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment, El Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home-SGF 01078
11.5 t, Address
ate 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
3
Permission is hereby granted to dispose of the human re n d b e a indicated.
Date Issued .-a.3—i Registrar of Vital Statistics ]
i v (signature)
District Number 5t6'1 Place
I certify that the remains of the decedent identified abo were disposed of in accor nce with this permit on:
i Date of Disposition 02/23/2015 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) (lot number) (grave number)
tioftv-
Name of Sexton or Person incharge f Premises ge.: .i�1><
please print)
Gam' (1ZI1.G+
Signature Title
(over)
DOH-1555 (02/2004)