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Rathbun, Greta NEW YORK STATE DEPARTMENT OF HEALTH �� Vital Records Section > ` Burial - Transit Permit Name First Middle Last Sex Greta Christine Rathbun Female Fa Date of Death Age If Veteran of U.S. Armed Forces, Jan. 14, 2012 60 yrs. War or Dates no Place of Death Hospital, Institution or Z City, Town or Village Glens Falls Street Address Glens Falls Hospital 0 Manner of Death®Natural Cause El Accident n Homicide Suicide ri Undetermined Pending W. Circumstances Investigation ill Medical Certifier Name Title 0 Sean Bain MD. Address 100 Park St_ , Glens Falls, NY 128.01 i Death Certificate Filed District Number Register Number City, Town or Village G 1 P n s Fa 1 1 G 5601 ❑Burial Date Cemetery or Crematory ['Entombment 17, 2012 PineView Crematorium Address ©Cremation Queensbury, NY. 12804 Date Place Removed 3 El❑Removal and/or Held �= and/or Address Hold O. Date Point of IL i—i Transportation Shipment Li by Common Destination Carrier Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address E. Permit Issued to Registration Number Name of Funeral Home Mason Funeral Home 01117 <'': Address 18 George St. , Fort Ann, NY. 12827 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above 2 Address 0 iti CL Permission is hereby granted to dispose of the human remains describe bove as in ' ate Date Issued 1 /1 6/2 01 2 Registrar of Vital Statistics . t�� (signa ure) IVIlilil District Number 6-6O) Place City of Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ti ILI Date of Disposition 1/II ilL Place of Disposition Zt V i1 i(J 6/1-cl uiv� (address) fa til ig (section) t _ (lot number) (grave number) CI Name of Sexton or Per on in Charge f Premises h r,sA r" 3(Ar dt (please print) 10 Signature 1 Title Ca- ry oiL Y (over) DOH-1555 (02/2004)