Winslow, Alfred NEW YORK STATE DEPARTMENT OF HEALTH 41 ` It
Vital Records Section - Burial - Transit Permit
Name First Middle Last Sex
Alfred James Winslow Male
Date of Death Age If Veteran of U.S. Armed Forces,
July 22, 2013 50 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Warrensburg Street Address 186 Rollies Road
Manner of Death❑ Natural Cause X❑ Accident ❑ Homicide ❑ Suicide n Undetermined III Investigation
Medical Certifier Name Title
Paul F. Bachman,
Address
:4 3767 Main Street Warrensburg, NY 12885
Death Certificate Filed District Number Register Number
City, Town or Village Warrensburg b �,(P
❑Burial Date Cemetery or Crematory
July24, 2013 Pine View Cemetery
❑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
IReinterment Date Cemetery Address
V. Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home 01078
Address
136 Main Street, South Glens Falls NY 12803
Name of Funeral Firm Making Disposition or to Whom
s Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human re. ns escribed abo a as ind' ated.
Date Issued a ripy coo 13 Registrar of Vital Statistics / ? ? �°u�" 1-? _
l si nature
( g )
District Number 3(pLe6 Place Ilya rr1/2,A,f,'c�
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 07/24/2013 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) (lot number) c (grave number)
• Name of Sexton or Person i harge of Pre ses dottlieJ cv(pse print)
Signature Title a t»r e
(over)
DOH-1555 (02/2004)