Tilford, Marjorie E NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Biostatistics Vital Records Section
Name First Middle Last sex
Mar'orie_- Elizabeth Tilf ord female
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Date of Death Age If Veteran of U.S.Armed Forces,
Jan 29, .
1990 67 War or Dates -0-
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Place of Death Hospital, Institution or
:W -49ityXIAffiff Village Hudson Falls Street Address
26 Catherine St.
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Cause of Death
Metastaic Colon Cancer
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Medical Certifier Name Title
Mark Hoffman MD
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Address
88 Broad St. , Glens Falls, NY
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Death Certificate Filed ...District Number Register Number
WZA xVillage Hudson Falls 5726
Date Cemetery or Crematory❑Burial
Feb. 1. 1990 Pineview Cremator
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Cremation r Address
Town of Queensburv, NY
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Zi Date Place Removed
El Removal
and/or Held
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and/or Hold ......
Address
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Point of
bate
0. ElTransportation by::
Shipment
Common Carrier ..... .............
Destination
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171 Disinterment Date Cemetery Address
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Cemetery Address
....... Date
... Reinterment
El
Permit Issued to Registration Number
Name of Funeral Firm Carleton Funeral Home Inc. 00310
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;.::::Address
68 Main St. , Hudson Falls, NY 12839
Funeral..... ...................."--............... ................ ............................... ......................................
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
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i�i Address
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Permission Is hereby granted to dispose of the hurna remnnains described above as Indicated.
Date Issued January 31,1 9 Registrar of Vital Stati
stics
(signatum�r
District Number 5726 Place Village of Hudson Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ALI
4-
Date of Disposition 9-ot-9!7 Place of Disposition /o/ e,If 1,47e/f)ZJIK
(address)
LuGC
(section) (lot number) (grave number)
Name of Sexton jr Person in Charge o Premises
(please print)
W.
Signature Title e�izf2FAM Ze�j
DOH -1555(9/86)p 1 of 2(formerly VS-61)