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Calcagne, Lillian NEW YORK STATE DEPARTMENT OF HEALTH s 3 � Vital Records Section Burial - Transit Permit Name First Middle Last Sex _ Lillian Margaret Calcagne Female Date of Death Age If Veteran of U.S. Armed Forces, March 11, 2013 88 War or Dates Place of Death Hospital, Institution or City, Town or Village /J egy,,2 Street Address Pleasant Valley Health Center Manner of Death❑ ❑ ❑ n n Undetermined ❑ Pending X Natural Cause Accident Homicide Suicide -- Circumstances Investigation Medical Certifier Name Title Edit Masaba, MD Dr. Address 200 Main Street Greenwich, NY 12834 Death Certificate Filed District Number ���` Register Number t City, Town or Village 5U • rid i,. >❑Burial Date Cemetery or Crematory March 13, 2013 Pine View Crematory ❑Entombment Address© n Cremation C (U e e(nS burl , N Y , ❑ Removal Date Place Removed and/or and/or Held Pine View Crematory Hold Address Date Point of ❑Transportation Shipment Yk byCommon Destination k= Carrier ElDisinterment Date Cemetery Address Reinterment Date Cemetery Address ,''.- 4'2 Permit Issued to Registration Number Name of Funeral Home M. B. Kilmer Funeral Home 01077 Address V-1 123 Main St., Argyle NY 12809 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is ereb granted to dispose of the human r ains descr'bedaabove as indicated. Date Issued I Registrar of Vital Statistics �l 1 \ � lC -- (signature) District Number Gr)Sb Place 001916. %= I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 03/1,9`Z013 Place of Disposition p,v, , ,g4-z„,L (address) (section) , _ o num r) ] (grave number) Name of Sexton or erson i Ch Premises C-d'6�1 6 ��» Q .r� Signature Title a ,, easePrint) ✓ (over) DOH-1555 (02/2004)