Eggleston, Marion NEW YORK STATE DEPARTMENT OF HEALTH.
Vital Records Section Burial - Transit Permit
Name First Middle Last
Sex
Marion G. Eggleston Female
Date of Death Age If Veteran of U.S. Armed Forces,
September 30, 2014 89 War or Dates
Place of Death Hospital, Institution or
la: Manner
City, Town or Village Fort Edward Street Address Fort Hudson Nursing Home
Manner of Death 0 Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
4- Circumstances Investigation
Medical Certifier Name Title
a Philip J. Gara, Dr.
Address
318 Broadway Fort Edward 12828
Death Certificate Filed District Numb �� Regis r umber
City, Town or Village Fort Edward
❑Burial Date Cemetery or Crematory
October 1, 2014 Pine View Crematory
'' 4 u Entombment Address
;y, El Cremation Quaker Road Queensbury,NY 12804
,_' Date Place Removed
❑ Removal and/or Held
and/or Address
4''= Hold
Date Point of
1 ElTransportation Shipment
by Common Destination
Carrier
. ❑ Disinterment Date Cemetery Address
❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
$s Name of Funeral Home M. B. Kilmer Funeral Home 01077
1:a_ Address
4n 123 Main St., Argyle NY 12809
Name of Funeral Firm Making Disposition or to Whom
i s• Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human r e'ns describ d a ve a indicated.
Date Issued I 0/011Z0V4 Registrar of Vital Statistics r
______,_ si nature)
District Number 87E5 Place J 1YL
1J
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 10/01/2014 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises •» -Se fteelf.
,( please print)
r= Signature G lii-- /L-- Title Nn174
(over)
DOH-1555 (02/2004)