Weast, Nora NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last 1 Sex
Nora Weast Femal e
Date of Death Age If Veteran of U.S. Armed Forces,
6/13/1997 86 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address GF Hospital
Manner of Death Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Gerald Schynoll, MD
Address
2 Broad St. Plaza Glens Falls NY 12801
'' ----F
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls Q
fj
Date Cemetery or Crematory
❑Burial 6/16/1997 Pine View Crematory
Address
LJCremation Quaker Rd. Queensbury, NY 12804
gDate Place Removed
Removal and/or Held
and/or Address
Ili-
Hold
Date Point of
[]Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral HomeM.B. Kilmer Funeral Home 01055
Address
6401 Main St. , Argyle, NY 12809
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 abboo e as iqAtpated.
Date Issued 6 16` G7 Registrar of Vital Statistics
(signature)
District Number 5 Place S S-0
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition]-fa/- Place of Disposition �/�/1��J% / �4/ �i Q��/�/'d 4
(address)
Uj
W
(section) �l (lot number) (grave number)
0 Name of Sexto or Pers n in Charge of Premises ,�P. !�//T�D /YI 4 T f
g (please print)
19 Signature Title
DOH-1555 (10/89) p. 1 of 2 VS-61