Tougaw, Linda NEW YORK STATE DEPARTMENT OF HEALTH �S�2,b
Vital Records Section Burial - Transit Permit
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A.
Name First Middle Last Sex
cv
Linda Marie Tougaw Female
14' Date of Death Age If Veteran of U.S. Armed Forces,
September 22, 2013 63 War or Dates
Place of Death Hospital, Institution or
- City, Town or Village Fort Edward Street Address 4 Brightwood Street
Manner of Death X❑ Natural Cause n Accident ❑ Homicide ❑ Suicide ❑ Undetermined El 1---I Pending
CircumstancesInvestigation
Medical Certifier Name Title
John P. Stoutenburg, Dr.
Address
102 Park Street Glens Falls, NY 12801
A Death Certificate Filed District Numb Register Number
City, Town or Village Fort Edward ,`),
0 Burial Date Cemetery or Crematory
O September 24, 2013 Pine View Crematory
v ❑Entombment Address
AV®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
. ❑ Removal and/or Held
and/or Address
Hold
Date Point of
;fi , ❑Transportation Shipment
by Common Destination
Carrier
❑ Disinterment
Date Cemetery Address
IIIRenterment
Date Cemetery Address
.
Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home 01079
P. Address
82 Broadway; Fort Edward NY 12828
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is h re y ranted to dispose of the huma J sins describ d bove s indicate .
Date Issu Registrar of Vital Statisti• t.lf
___-------- (signature)
may' District Numbe` —75 Place,4jt 7ck ��Jg
g I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 09/24/2013 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises it"{ .� Jtn-d'�
( ase print)
Signature Title lit mut
(over)
DOH-1555 (02/2004)