Brown, Darlene O
NEW YORK STATE DEPARTMENT OF HEALTH /
la N
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Darlene Marie Brown Female
-, Date of Death Age If Veteran of U.S. Armed Forces,
July 28, 2014 63 War or Dates
Place of Death Hospital, Institution or
# 3: City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death Natural Cause III
ElHomicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
Medical Certifier Name Title
fin Joseph h C. Mihindu, M.D. Dr.
Address
52 Park St. Glens Falls, NY 12801
Death Certificate Filed District Number Register umber
P. City, Town or Village Glens Falls S 601 3
= '❑Burial Date Cemetery or Crematory
r. - July 31, 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
t Date Cemetery Address
❑ Reinterment
Permit Issued to Registration Number
, Name of Funeral Home M. B. Kilmer Funeral Home 01079
Address
82 Broadwa , Fort Edward NY 12828
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 remains described above as indicate .
t Date Issued -7 f 3 p/ /Li Registrar of Vital Statistics UJ eKA4„-2, Ls''.)
(signature)
liki District Number S 6 c� Place6 ca,v\s- -.), \:\s \iv y
„
.k kI certify that the remains of the decedent identified above were disposed of in accordance with thispermit on:
er Date of Disposition 07/31/2014 Place of Disposition Quaker Road Queensbury,NY 12804 g, ,"y„/1.....)
(address)
(section) 0numbet') (grave number)
Name of Sexto S.in'r arge of Premises � G�'!
, �/ /L t Title ntrG
A Signatur Title
(over)
DOH-1555 (02/2004)