Hurley, Margaret I 434
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
iim
Margaret E. Hurle emalP
Date of Death Age 1 If Veteran of U.S. Armed Forces,
Apr 1 19, 2018 88 yrs. Waror Datesno
h Place of Death Hospital, Institution or
Z City, Town or Village Fort Arm Street Address 1 5 George St _
:5 Manner of Death 0 Natural Cause El Accident ❑Homicide III Suicide ❑Undetermined 0 Pending
Atil Circumstances Investigation
12 Medical Certifier Name Title
itl Eileen Spinelli ANP
Address
iiiii 161 rarey Pd., Oueensbury.. NY. 12804
Death Certificate Filed Distritumber Register Number
City, Town or Village Fort Ann 5723
Date Cemetery or Crematory
❑Burial April 20, 2018 PineView Crematorium
Address
E Cremation Oueensbury, NY_ 12804
Date Place Removed
Z ❑Removal and/or Held
rf and/or Address
I- Hold
Q Date Point of
N ❑Transportation Shipment
G by Common Destination
Carrier
::: Disinterment
Date Cemetery Address
Date Cemetery Address
Reinterment Permit Issued to Registration Number
Name of Funeral Home Mason Funeral Home 01117
1 1 10
I:i Address
18 George St. , PO. Box 277, Fort Ann, NY. 12827
iiiiiii Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
w
F4
Permission is hereby ranted to dispose of the human remains described ab a as indicated.
ilill Date Issued 9 0 �6 Registrar of Vital Statistics 6p , p Ge .��t l'�
N
(signal re)
District Numbers7o�. Place Cr,- `t-- 7y-- 7 S�7
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
aDate of Disposition link Place of Disposition eM t.-I lR "0,.--
2 (address)
JW
CC (section) /� (lot numbe (grave number)
Name of Sexton or Person in Charge of Premises ` Lr.:IrL i4.01
fit
Ci
4 (please print)
JAI Signature Title hifrH6iL.
DOH-1555 (10/89) p. 1 of 2 VS-61