Hooker, Metta NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Metta Gertrude Hooker Female
Y,, Date of Death Age If Veteran of U.S. Armed Forces,
April 9, 2013 89 War or Dates
� =- Place of Death Hospital, Institution or
' City, Town or Village Queensbury Street Address 71 Longview Drive Apt 241
Manner of Death M Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
T,
Circumstances Investigation
Medical Certifier Name Title
Philip J. Gara,
Address
318 Broadway Fort Edward 12828
Death Certificate Filed Dist ict Number R gister Number
t L Ci Town or Villa a Queensbury
❑Burial Date Cemetery or Crematory
n- April 10, 2013 Pine View Crematory
0 Entombment Address
x®Cremation Quaker Road Queensbury,NY 12804
Date I Place Removed
' ❑ Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
❑ Disinterment Date Cemetery Address
r Q ElRenterment Date Cemetery Address
Permit Issued to Registration Number
-_ Name of Funeral Home M.B. Kilmer Funeral Home 01078
Address
136 Main Street, South Glens Falls NY 12803
R Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human rgm�ins described above as indicated.
Date Issued 1100 %Registrar of Vital Statistics `r>C,_.,_ c C.l (L."
(signature)
District Numbe6(0 -1 Place d c,.�r- 0 (A-L-P/), ID
I certify that the remains of the decedent identified above were disposed of in accordance with thi permit on:
Date of Disposition 04/10/2013 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) _ (lot number) < (grave number)
Name of Sexton or Per on in Charge f Premises tics ` Schiff'
( lease print)
Title C kj NI Ki6o
Signature � 4-
(over)
DOH-1555 (02/2004)