Curley, Ida NEW YORK STATE DEPARTMENT OF HEALTH ` ti -1 $3
Vital Records Section Burial - Transit Permit
:; Name First Middle Last Sex
Ida Bertha Curley Female
#; Date of Death Age If Veteran of U.S. Armed Forces,
July 14, 2014 84 War or Dates
Plac- Beath Hospital, Institution or
3 City, own .r Village- t(-) - a j Street Address
Mann Death X❑ Natural Cause ❑ Accident ❑ Homicide 0 Suicide ❑ Undetermined ri❑ Pending
, Circumstances Investigation
Medical Certifier Name Title
a Philip J. Gara, Dr.
Address
318 Broadway Fort Edward 12828
.14 Death Certificate Filed District Number Registe- tuber
'14- City, Town or Village Vo r- - CAL)�A 67s c
❑Burial Date Cemetery or Crematory
July 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
❑ Disinterment
Date Cemetery Address
FA❑ Reinterment Date Cemetery Address
t Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home 01078
l' Address
136 Main Street, South Glens Falls NY 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is h reb granted to dispose of the human r ains describ d ab e as indicated.
Date Issued /5 Registrar of Vital Statistic �
_----- (sig to
t
District Number57Ss Place JAW) l 74 f c u Qt
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 07/15/2014 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) (lot numbe� (grave number)
Name of Sexton or Person i Charge of remises re ua' ...)tNrf(i-
" _ ,(please print)
Signature / Title Caf 140
(over)
DOH-1555 (02/2004)