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Gifford, Linda NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section * Burial - Transitrm it -: Name First Middle Last Sex Linda Mary Gifford Female Date of Death Age If Veteran of U.S. Armed Forces, June 7, 2012 54 War or Dates ice•, Place of Death Hospital, Institution or City, Town or Village Street Address Glens Falls Hospital i-T Manner of Deathrn iLxi Natural Cause 0 Accident 0 Homicide 0 Suicide uUndetermined ri Pending Circumstances Investigation Medical Certifier Name Title Marvin Davidowitz, Dr. Address Glens Falls Hopital Glens Falls, NY 12801 Death Certificate Filed District Number Register Number City, Town or Village 56o 1 2. `2-7 0 Burial Date Cemetery or Crematory June 8, 2012 Pine View Crematory ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed Removal and/or Held - and/or Address - Hold ` Date Point of 0 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 82 Broadway, Fort Edward NY 12828 Name of Funeral Firm Making Disposition or to Whom f Remains are Shipped, If Other than Above Address `®- , Permission is hereby granted to dispose of the human remains described above as indicated. - Date Issued 6/g-)//2 Registrar of Vital Statistics c Q / i (signature) District Number S60/ Place 6 (J Jv. S L 1 S/ GU y' a I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: fri Date of Disposition 06/08/2012 Place of Disposition Quaker Road Queensbury,NY 12804 (address) (section) (lot number) (grave number) 711-ril-qi,r- S�e �: Name of Sexton or P rson in Charge of Premisesase print) 11- Signature Title CV, i,W (over) DOH-1555 (02/2004)