Loading...
King, Mary NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Vital Records Section Name First Middle Last Sex Mary Ellen Kincr Female -P Date of Death Age If Veteran of U.S. Armed Forces,71 War or Dates ''>'Place of Death Hospital, Institution or City, T Street Address ::::::::Manner of Death Undetermined Pending Natural Causes❑Accident ❑ Homicide ❑ Suicide ❑ Circumstances ❑ Investigation Medical Certifier Name Title Robert L_ Evans n0 Address Death Certificate Filed District Number Register Number City, T�i Glens Falls 5601 —7 ❑ Burial ate Cemetery or Crematory Febnlary 16, 1999 Pine View Crematorium © Cremation Address Tn of Queensbury, NY 12804 Date Place Removed ❑ Removal and/or held and/or hold Address Date Point of ❑ Transportation by Shipment Common Carrier Destination Date Cemetery Address ❑ Disinterment Date Cemetery Address ❑ Reinterment ermit issued to Registration Number :::.::.::.::.:Name of Funeral Firm Carleton Funeral Hone Inc. 00313 Address P.O. BcDt 67, 68 Main St., Hudson Falls, N.Y. 12839 Name of Funeral Firm Making Disposition or to Whom ..........Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicate Date Issued 2� �- (9 Registrar of Vital Statistics (Signature) :::;::'District Number 5601 Place Glens Falls, NY 12801 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: // / / ` ^/f Date of Dispositio 7/61 Place of Disposition �� � d v (address) Q (Section) (Lot Number) / (Grave Number) Name of Sexto or Person i Charge of Pre 'ses � v —`' (Please Print) Signatur Title DOH-1555 (10/89) p. 1 of 2 VS-61