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Vorosmarty, Anna NEW YORK STATE DEPARTMENT OF HEALTH t 'R ti sr. Vital Records Section Burial - Transit t'ermit Name First Middle Last Sex Anna Vorosmarty Female Date of Death Age If Veteran of U.S. Armed Forces, September 21, 2013 79 War or Dates Place of Death Hospital, Institution or City, Town or Village Argyle Street Address Pleasant Valley Manner of Death Natural Cause ID Accident 0 Homicide 0 Suicide 0 Undetermined r7 Pending Circumstances Investigation g Medical Certifier Name Title Edit Masaba, MD Dr. wr Address PA 200 Main Street Greenwich, NY 12834 • Death Certificate Filed District Number575b Register Number ; City, Town or Village Argyle oC`4 ❑Burial Date Cemetery or Crematory September 23, 2013 Pine View Crematory 0 Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed El Removal and/or and/or Held Hold Address Date Point of e! Transportation Shipment 1J by Common Destination Psi Carrier Disinterment Date Cemetery Address - Reinterment4,r, Li Date Cemetery Address 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 ii - P• ermission is hereb granted to dispose of the human remai, described v as indicated. Registrar of VitalStatistics • G Date Issued 0 ii ��` U� Vi (signature) D• istrict Number 5 Place ( Cf(1/.Q '7 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: t Date of Disposition 09/23/2013 Place of Disposition Quaker Road Queensbury,NY 12804 (address) (section) t number) (grave number) • Name of Sexton or Person in Charge of remises 'iflr St"eJ't- (pleas print) Signature Title aft4itiaIt (over) DOH-1555(02/2004)