Ball, Louanne NEW YORK STATE DEPARTMENT OF HEALTH f it
3 03
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Louanne Elizabeth Ball Female
Date of Death Age If Veteran of U.S. Armed Forces,
May 22, 2013 70 War or Dates
Place of Death Hospital, Institution or
' City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death m Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined 1-1 Pending
FE Circumstances Investigation
Medical Certifier Name Title
Graham Atkins, Dr.
I, Address
161 Carey Road Queensbury, NY 12804
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 6-60/ ZV
❑Burial Date �1, Cemetery or Crematory
5f � 1 Pine View Crematory
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
Vic ❑ Removal and/or Held
and/or Address
n
Hold
Date Point of
❑Transportation Shipment
by Common Destination
'` Carrier
❑ Disinterment Date Cemetery Address
ElReinterment Date Cemetery Address
` a Permit Issued to Registration Number
T - Name of Funeral Home M.B. 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 hereb granted to dispose of the human remains descri a v s i ed.
Date Issued .0,53/Z0/3Registrar of Vital Statistics
_ // (signature)
District Number J 60/ Place j/Qy„o /n` /C%/
.. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 3/Alp Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) / (lot number) (grave number)
Name of Sexton or Person i Charge of P emises G /AL 11prld-
(please print)
Signature Title « PPItIt
(over)
DOH-1555 (02/2004)