Durkee, David NEW YORK STATE DEPARTMENT OF HEALTH I L) 1
Vital Records Section c- .- i Burial - Transit Permit
Name First Middle Last Sex
David Paul Durkee Male
Date of Death Age If Veteran of U.S. Armed Forces,
2/16/2012 64 War or Dates
li.4, Place of Death Glens Falls Hospital, Institution or
Z City, Town or Village Street Address Glens Falls Hospital
Manner of Death 0 Natural Cause 0 Accident 0 Homicide 0 Suicide ri Undetermined ri Pending
t Circumstances Investigation
ig Medical Certifier Name Title
Tucker Slingerland, MD Dr.
syii,t A s efrz .. iJ As. —
Death Certificate Filed District Number Register Number
iM City, Town or Village
is Burial Date Cemetery or Crematory
2/17/2012 Pine View
0 Entombment' Address
' E Cremation Quaker Rd Queensbury, NY 1 2804
Date Place Removed
Z❑Removal and/or Held
and/or Address
i=" Hold
0
Date Point of
Transportation Shipment
el by Common Destination
ip Carrier
Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to M.R. Kilmer Funeral Home Registration Number
Name of Funeral Home 01 077
iin Address
123 Main St Argyle, NY 12809
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above _
Address
#i
Ili
Permission is hereby granted to dispose of the human reyrtains described ove as in• cated.
Date Issued Registrar of Vital Statistics -tom -
'� ignature)
District Number ��O f Place ( .) 71-1:e2 (
_�,�=�V G-
I certify that the remains of the decedent identified above were disposed of in accordance ith this permit on:
LAI Date of Disposition 6 Z LUt2, Place of Disposition ev., 1, 6.40tiu.
(address)
I
i
C (section) 11 -(lot umber) r /' (grave number)
il Name of Sexton or Pers in Charge o Premises r,0`T Etir l
(phase print)
Signature 7 ' Title Cil6frOit
9 i
(over)
DOH-1555 (02/2004)