McNeil, Susan NEW YORK STATE DEPARTMENT OF HEALTH 'r is 4 110
Vital Records Section Burial - Transit Permit
.77
Name First Middle Last Sex
`rn Susan E. McNeil Female
4 Date of Death Age If Veteran of U.S. Armed Forces,
ter;
January 10, 2014 54 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Cambridge Street Address 47 West Main Street
Manner of Death 0 Natural Cause 0 Accident El Homicide El Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
E
James Gariepy,
Address
19 East Broadway Salem, NY 12865
Death Certificate Filed District Number Register Number
City, Town or Village Cambridge
❑Burial Date Cemetery or Crematory
-61 January 15, 2014 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
❑Transportation Shipment
;_ by Common Destination
Carrier
toz: ❑ Disinterment
Date Cemetery Address
Ary
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home 01077
Address
123 Main St., Argyle NY 12809
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
z Permission is hereby granted to dispose of the human remai described abo indicated.
' Date Issued t l 114 i t [ Registrar of Vital Statistics ► . ,--1,zt-e•c--,A7.z z-1 ____-
(signature)
District Number 5 7a 1 Place srra, '"'i()
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 01/15/2014 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) (lot number) (grave number)
' Name of Sexton or Person i harge of Pr mises ru`i`p e Sett
(please print)
mflfole-
Signature -- Title
(over)
DOH-1555(02/2004)