Mahon, Rita NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name Firgli Marie Middle Mahon Last Sex
Female
`< Date o �fi995 Age 77 If Veteran of U.S. Armed Forces,
War or Dates
Place of Death Hospital, Institution or
City, Town or Village Argyle Street Address Route 40, Argyle
Manner of Death Natural Cause ❑Accident Homicide ❑Suicide Undetermined ❑Pending
Circumstances Investigation
Medical Cart jer Jensen, %D Title
62lgslain St. Argyle NY 12809
;x< Death Certificate Filed Argyle District Number 2 Register Dumber
;Ci ,Town orW la e = `
Date 1/ 2/1995 Cemetery ier View -C Crematoematory
qBurial
Ad es
Cremation Quaker❑ ker Rd. , Queensbury, NY 12804
Date Place Removed
Removal and/or Held
FEI
/or Address
d
Date Point of
nsportation Shipment
Common Destination
Carrier
Date Cemetery-Address
E]Disinterment...
Reinterment Date Cemetery Address_
Permit Issued to _ Registration Number
Name of Funeral Home M.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=ins descri d above as indicated.
Date Issued vZ I Registrar of Vital StatisticsJ.-ta,
ignature)
District Number ao . Place
certify that the remains of the decedent identified above were disposed of in accordance with-this permit on'.
� r / n �
Date'of Disposition - Place of Disposition J //1/,� ,e��� C/t �/!'�/� /(�j LIA
(address)
(section) (lot number) ) (grave number)
�- Name of Sexton or Person in Charge of Premises z�,G xpo eA/
(please print)
Signature Title
DOH-1555 (10/89) p. 1 of 2 VS-61