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Waterhouse, Margaret *It NEW YORK STATE DEPARTMENT OF HEALTH s - k `� z 1 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Margaret Waterhouse Female Date of Death Age If Veteran of U.S. Armed Forces, August 5, 2014 81 War or Dates Place of Death Hospital, Institution or ` City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death 17rI Lai Natural Cause n Accident 0 Homicide 0 Suicide Undetermined ri Pending Circumstances Investigation Medical Certifier Name Title Address Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5-40/ 3�d ❑Burial Date Cemetery or Crematory August 11, 2014 Pine View Crematory wA 0 Entombment Address ;_ ®Cremation Quaker Road Queensbury,NY 12804 Date Place Removed Removal and/or Held and/or Address Hold Date Point of ❑Transportation Shipment 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 01079 '. Address 4 82 Broadway, Fort Edward NY 12828 n Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address .` Permission is hereby ranted to dispose of the human remains desc 'byd aabo/vle"�as • • ted. Date Issued © Or�!j Registrar of Vital Statistics � � L� '/ j�// (signature) District Number 40f Place Co% ' // /iv 7Z3Oi I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 08/11/2014 Place of Disposition Quaker Road Queensbury,NY 12804 (address) (section) (lot number)(' (grave number) '' Name of Sexton or Person in Charge of Premises t G. 340,4 ( ease print) Signature A---' ./Iirr-- Title (over) DOH-1555 (02/2004)