Alekema, Margaret NEW YORK STATE DEPARTMENT OF HEALTH g 31.
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Margaret Ellen Alekema Female
Date of Death Age If Veteran of U.S. Armed Forces,
07/13�20 2 72 years War or Dates
Place of Death Hospital, Institution or
141 X City, To V Street Address Clens �I� How ital
�XMO( Glens Fa ndeDrmmed Manner 6�Deat ✓atural Cause 11 Accident ❑Homicide ❑Suicide ❑Pending
Ui O.
Circumstances Investigation
ui Medical Certifier Name Title
4
Address Bain M D
100 Park St. Glens Falls, N Y 12 lot
Death Certificate Filed District Number Register Number
City, To `CV�X Glens Fade 5601 3,37
❑Burial ate Cemetery or Crematory
❑Entombment Address07/16/2012 Pineview Crematory
:;: ;❑cremation •
Queensbury, N Y 12804
Date Place Removed
Z❑Removal and/or Held
and/or Address
I= Hold
CO
0 Date Point of
cti❑Transportation Shipment
3 by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
M. Permit Issued to Registration Number
Name of Funeral Home Wilcox R Regan Funeral Home 01821
Address d O Z
11 Algonkin Street Ticonderoga N Y (Z D D
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
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"` Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/16/2012 Registrar of Vital Statistics (N Cc. R. /\) 1•A-Svv ASt-
(signature)iiii
District Number Place
Ziiii 5601 Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
k
ILI Date of Disposition 1-13-it Place of Disposition „AcUuI.1 T.ra-.- L.rto ,
(address
Lii
VI
CC (section) / (lot number) (grave number)
CI Name of Sexton or Person in Charge f Premises 4Ilnat r Se'4
T(please print)
lif
AL
iitSi nature Title Cal A,
(over)
DOH-1555 (02/2004)