Fellows, Marie NEW YORK STATE DEPARTMENT OF HEALTH N
Vital Records Section - Burial - Transit Permit
Name First Middle Last Sex
Marie Ann Fellows Female
,; Date of Death Age If Veteran of U.S. Armed Forces,
September 25, 2015 72 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Argyle Street Address Washington Center
Manner of Deathifi Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ElUndetermined El"—I Pending
CircumstancesInvestigation
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Medical Certifier dame Title
Address-7
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Death Certificate Filed District Ni'mber Register Number
City, Town or Village Argyle 575-0 5-o
0 Burial Date Cemetery or Crematory
September 28, 2015 Pine View Crematory
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
[1 Removal and/or Held
I I and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Ci Carrier
Date Cemetery Address
❑ Disinterment
Date Cemetery Address
El Reinterment
Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home-Argyle 01077
Address
123 Main St., Argyle NY 12809
Name of Funeral Firm Making Disposition or to Whom
j Remains are Shipped, If Other than Above
Address
it
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued I i)IS Registrar of Vital Statistics ` � 'II" L I2.u+ �
(signature)
District Number S'-)Sz, Place G,J1
1 Le I tilt'
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
rr Date of Disposition 09/28/2015 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
Tr
Q (section) 4 (lot number&„ (grave number)
Name of Sexton or Person in Charge of Premises rl t" `
Pease print)
', Signature A Title d.-
(over)
DOH-1555 (02/2004)