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Bauer, Merry NEW YORK STATE DEPARTMENT OF HEALTH -v 3 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Merry Jo Bauer Female Date of Death Age If Veteran of U.S. Armed Forces, May 6, 2015 79 War or Dates Place of Death Hospital, Institution or City, Town or Village Queensbury Street Address The Stanton Nusing and Rehabilitation Manner of Death j Natural Cause ElAccident ❑ Homicide ❑ Suicide 1 Undetermined ri❑ Pending Circumstances Investigation dMedical Certifier Name Title Address Deat rtificate Filed ict Number Regi r Number City Town r Village Queensbury pV 1 ) 16 ❑Burial Date Cemetery or Crematory o'izMay 6, 2015 Pine View Crematory ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Removal Date Place Removed ❑ and/or and/or Held Hold Address Date Point of ❑Transportation Shipment 1 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-SGF 01078 Address 136 Main Street, South Glens Falls NY 12803 Name of Funeral Firm Making Disposition or to Whom It Remains are Shipped, If Other than Above Address ; F Permission is hereb granted to dispose of the human re ai described ab ve as indicated. Date Issued (.S? erc Registrar of Vital Statistics rr Y� lJ �� (signature) District Numbers( ) Place 0 L—ems a ( LL I certify that the remains of the decedent identified above were disposed of in acco ance w. h this permit on: If•-: Z I, ZDate of Disposition 05/06/2015 Place of Disposition Quaker Road Queensbury,NY 12804 (address) W (section) apt number) (grave number) Name of Sexton or Person in Char a of Premises /4r,.tri., .Lot A (pllease print) 1-X Signature Title f 4419t (over) DOH-1555 (02/2004)