Macker,Laura Lea NEW YORK STATE DEPARTMENT OF HEALTH (1-7F.)
.T ` S i ��
Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Laura Lea Macker Female
Date of Death Age If Veteran of U.S.Armed Forces,
10/14/2022 53 Years War or Dates
p Place of Death
Hospital,Institution or
WCity,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death El Natural Cause EAccident El Homicide ESuicide FlUndetermined ri Pending
W
I—j
U Circumstances Investigation
W Medical Certifier Name Title
CI 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 531
EBurial Date Cemetery,Crematory or Facility Name
10/20/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
and/or and/or Held
H Hold Address
CO
0
a. Date Point of
Cl)❑Transportation Shipment
CI by Common
Carrier Destination
Disinterment Date Cemetery Address
0 Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
F— Remains are Shipped,If Other than Above
a Address
CC
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/19/2022 Registrar of Vital Statistics Megan Nolin(ECectronicallySigned)
(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:
I—
Z Date of Disposition Io ilo Place of Disposition `FAA L Z4---
2 (address)
W
NCC (section) (lot number) (grave number)
O Name of Sexton or Person in Charge of Pre ' es n� L.- tiiI
(pleale print/
..&
W Title (1i 6r118 �
Signature
DOH-1555(o7/18)p 1 of 2
'y 4 )
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#