Guthrie, Isabelle NEW YORK STATE DEPARTMENT OF HEALTH {
-A 519
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Isabelle
Guthrie Female
Date of Death Age If Veteran of U.S. Armed Forces,
August 12, 2015 98 War or Dates
! f Place of Death Hospital, Institution or
City, Town or Village , kfi-r '1.e Street Address The Orchard Nursing Home
1 Manner of Death 0 Natural Cause 0 Accident 0 Homicide 0 Suicide Undetermined El Pending
Circumstances Investigation
1_ Medical Certifier Name T' e
Nor �►
Address
t s1 ,2 L! 41Ie ✓w 1 - 2
Death Certificate Filed ^ \ District Number Register Number
1 City, Town or Village �� U1 G 1\ �� (j
0 Burial Date Cemetery or Crematory
August 13, 2015 Pine View Crematory
Entombment❑ Address
! Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
Removal and/or Held
Address
gM and/or
Hold
g.
Date Point of
,',1-❑Transportation Shipment
by Common Destination
Carrier
-.- ❑ Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
=A Permit Issued to Registration Number
A Name of Funeral Home M. B. Kilmer Funeral Home-Argyle 01077
Address
123 Main St., Argyle NY 12809
AA Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
lit
Permission is hereby granted to dispose of the human remains descried above as indicated.
Date Issued 8/ 13 J.- is- Registrar of Vital Statistics 1',.
AaT 0 1 1 (signature)
. District Number a rap Place 1 ' r CO-- lifter\\Y‘\\e__
s::14 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
i Date of Disposition 08/13/2015 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
;I
(section) //��(lot number) (grave number)
tf Name of Sexton or Person in Charge of Premises ti` ft.lert St^4M
4 (pl ase print)
;Ill Signature Title 4-9/1
(over)
DOH-1555 (02/2004)