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Liberty, Aimee A Z Z(,, NEW YORK STATE DEPARTMENT OF HEALTH/ A Vital Records Section Burial - Transit Permit Name First Middle Last Sex Aimee Christine Liberty Female Date of Death Age i If Veteran of U.S. Armed Forces, April 15,2013 32 War or Dates Place of Death Hospital, institution or Z City, Town or Village North Elba Street Address 2830 Wilmington Rd. p Manner of Death Natural Cause n Accident ,Homicide Suicide Undetermined x Pending W Circumstances Investigation w Medical Certifier Name Title G Frank Whitelaw Coroner Address 60 Maple Lane,Bloomingdale,NY 12913 Death Certificate Filed District Numbet560 Register Number/' City, Town or Village North Elba ❑Burial Date Cemetery or Crematory April 19,2013 Pine View Crematory Erttombmerrt Address _©Cremation 21 Quaker Rd., Queensbury, NY 12804 Date ' Place Removed Z Removal and/or Held O and/or Address H Hold tO O Date Point of NTransportation Shipment a by Common Destination Carrier I Disinterment Date ' Cemetery Address ri Reinterment Date I Cemetery Address 1 Permit Issued to Registration Number Name of Funerai Home M.B. Clark,Inc. 01075 Address 2310 Saranac Ave.,Lake Placid,NY 12946 Name of Funeral Firm Making Disposition or to Whom I— Remains are Shipped, If Other than Above 2 Address LU a. Permission is hereby granted to dispose of the human rem ins de crib above as indicated. Date Issued '/-/7- Registrar of Vital Statistics aim( A/de �� (si nature) District Number 1560 Place North Elba I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: � Date of Disposition N'L�'13 Place of Disposition r,��� (address) W Ce (section) / (I t number) �oto (grave number) pName of Sexton or Person in Charg of Premises L nj r Z tease print) WArL- Title CQ. i")ct c)(t Signature (over) DOH-1555(02/2004)