Reid, Goldie NEW YORK STATE DEPARTMENT OF HEALTH' ''i t'S
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Goldie M. Reid Female
IS Date of Death Age If Veteran of U.S. Armed Forces,
gi 01/31/2013 96 years War or Dates
f Place of Death Hospital, Institution or
,) ,or Village Village Of Malone Street Address Franklin County Nursing Home
W Manner of Death JJ Natural Cause Accident Homicide 0 Suicide Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
C Anjni Bhagat MD
Address
5 Clay Street Malone, NY 12953
IN Death Certificate Filed District Number Register Number
• 7C ,gig or Village Village Of Malone 1624 , 13
<>El Burial Date Cemetery or Crematory
❑Entombment 02/01/2013 Pine View Crematory
Address
;Cremation Queensbury, New York
Date Place Removed
Removal and/or Held
....i and/or Address
,E Hold
U)
0 Date Point of
Q Transportation Shipment
C3 by Common Destination
MI Carrier
Disinterment Date - Cemetery Address
Reinterment Date Cemetery Address
• Permit Issued to Registration Number
• Name of Funeral Home M. B. Clark, Inc 01075
Address
2310 Saranac Ave., Lake Placid NY 12946
gly Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
#r
w
Permission is hereby granted to dispose of the human remain 7lescribed above as indicated.
egiDate Issued 01/31/2013 Registrar of Vital Statistics / /, / ,,1 ogdfi1
(signatur)) a
District Number Place r
1 R24 Village of Malone
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z<.
lit Date of Disposition 2-j.(3 Place of Disposition .41...o i r41
(address)
tli
CC (section) (lot number) ca.1.. (grave number)
0 Name of Sexton or Pe son in Charge of Premises I A t�,1 ,
(phase print)
iiii Signature �� Title CIZ?lit ioC
(over)
DOH-1555 (02/2004)