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Halstead, Anna M.
k it Szc NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Anna M.Halstead Female Date of Death Age If Veteran of U.S.Armed Forces, 06/23/2021 98 Years War or Dates H Place of Death Hospital,Institution or WCity,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare p Manner of Death © Natural Cause 1=1 Accident 0 Homicide El Suicide11:1Undetermined 1=1 Pending W Circumstances Investigation W Medical Certifier Name Title Q Leonard Gelman MD Address 4573 State Route 40,Argyle Town,New York 12809 Death Certificate Filed District Number Register Number City,Town or Village Argyle 5750 43 ❑Burial Date Cemetery,Crematory or Facility Name 06/28/2021 Pine View Crematory ElEntombment Address 0 Cremation Queensbury Town,New York 0 Donation Z Removal Date Place Removed O and/or Held H and/or a Hold Address 0 CL Date Point of Cl) Li Transportation Shipment Q by Common — Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077 Address 123 Main St,Argyle,New York 12809 Name of Funeral Firm Making Disposition or to Whom - Remains are Shipped,If Other than Above Address 1E W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/28/2021 Registrar of Vital Statistics SFieffey Mckernon(E(ectronica(ry Signed) (signature) District Number 5750 Place Argyle, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Date of Disposition 6I Zi 11,1 Place of Disposition 'Rai‘"' Ltorli--. 2 (address) W CC (section) 4 (lot number) (grave number) 2 tQ Name of Sexton or Person in Charge of Pre ' s 5 `' �� Z /%/ (/l ase print) /� W Signature ��./ Title CoAL4 fat g �— DO H-1555(07/18)p 1 of 2 - Public Health Law Sec. 4145(2b) ' J .14 8 q 3 Receipt Human remains of ``=' delivered on - - , 20 Pine View Cemetery Representing the funefal home named on burial..pe ►' Official Funeral Directors Reg.or License# `'