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Lockwood, June • NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit • Name First Middle Last Sex June H. Lockwood Female Date of Death Age If Veteran of U.S. Armed Forces, Jan. 13, 2014 90 War or Dates NO Place of Death Hospital, Institution or uth Glens Falls W City, Town orVillaga Street Address 184 Main St,aiyuth Glens Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑(§ending Circumstances Investigation la Medical Certifier Name Title G? Glens Anderson MD Address 161 Carey Road Queensbury, New York 12804 Death Certificate Filed District Number Register Number City, Town or Villagouth Glens Falls ❑Burial Date Cemetery or Crematory Jan 14, 2014 Pine View Crematory ['Entombment Address ®Cremation 21 Quaker Road QuPPns awry, NY 12804 Date Place Removed Z❑Removal and/or Held and/or Address Lle Hold O - Date Point of 05 ❑Transportation Shipment a by Common Destination in Carrier El Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to M. B. Kilmer Funeral Home Rstraton Number Name of Funeral Home Address 136 Main St. South Glens Falls, New York 12803 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above • Address Permission is hereby granted to dispose of the human a ains describe above as indicated. Date Issued 1 -1 4-1 4 Registrar of Vital Statistic G - //.(el( (signature) District Number 415ay Place Village of South Glens Falls, NY I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ILI Date of Disposition I//h/el Place of Disposition eat tJ ! �t(ol/--- (address) Cl) CC (section) 4 (lot number) (grave number) • Name of Sexton or Person i Charge o Premises `h`r) r �en�k Tease print) ILISignature L Title C 1 / (over) DOH-1555 (02/2004)