Balle, Margaret Ann NEW YORK STATE DEPARTMENT OF HEALTH �2 I
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Margaret Ann Balle Female
Date of Death Age If Veteran of U.S.Armed Forces,
06/29/2022 75 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls
W Street Address Glens Falls Hospital
Q Manner of Death El Natural Cause Accident Homicide Suicide W ❑ ❑
Undetermined Pending
C.) Circumstances Investigation
QMedical Certifier Name Title
Asim Chaudry MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 344
Burial Date Cemetery,Crematory or Facility Name
07/01/2022 Pine View Crematory
[Entombment Address
Cremation Queensbury Town,New York
Donation
on Removal Date Place Removed
H and/or and/or Held
N Hold Address
0
d. Date Point of
Cl)❑Transportation
p by Common Shipment
Carrier Destination
ElDisinterment 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
I— Remains are Shipped,If Other than Above
2 Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/30/2022 Registrar of Vital Statistics Megan Nolin(ECectronica1TySigned)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 7 2—'Z Place of Disposition ri .Je t'e> c _v't.J`f j
(address)
W
CC (section) (lot nu ber) (grave number)
gName of Sexton or Person in Charge Premis I� / d�J (, (:et
Z lease print)
Signature � /f Titleetrct
DOH-1555(07/18)p t of 2
{ I ; ,
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#