Cooper, Margaret NEW YORK STATE DEPARTMENT OF HEALTH C `
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Margaret Ellen Cooper Female
Date of Death 0 9/22/201 3 Age 88 If Veteran of U.S. Armed Forces,
War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address 93 Fourth Street
Manner of Death Natural Cause Accident Homicide El Suicide El Undetermined ri Pending
Circumstances Investigation
Medical Certifier Name Title
Paul Filion MD
Address
2 Irongate Center, Glens Falls, NY 12801
Death Certificate Filed District Number 5-6 0 ( Register Numb r
City, Town or Village Glens Falls
❑Burial Date Cemetery or Crematory
09/23/2013 Pineview Crematory
Entombment Address
clCremation 21 Quaker Road, Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
and/or Address
Hold
Date Point of
Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home MB Kilmer Funeral Home
01078
Address
136 Main Street, South Glens Falls, NY 12803
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 remains described above as indicated.
Date Issued G ( 2 3! /3 Registrar of Vital Statistics WCIvkilrr‘s2
(signature)
District Number Jr'60 i Place 6 \s r N
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 7-ay- a 3 Place of Disposition f rt<_v 1'e:,J Ct'4wt a:-cc j An.
(address)
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises
(please print)
Signature Title
(over)
DOH-1555(02/2004)