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Brennan, Claire NEW YORK STATE DEPARTMENT OF HEALTH r ; tr fit! Vital Records Section Burial - Transit Permit Name First Middle Last Sex Claire Elizabeth Brennan Female Date of Death Age If Veteran of U.S. Armed Forces, October 30, 2017 91 War or Dates Place of Death Hospital, Institution or City, Town or Village Argyle Street Address 219 Durkeetown Road WManner of Death Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending Circumstances Investigation WW Medical Certifier Name Title Philip J. Gara, Dr. Address 318 Broadway Fort Edward 12828 Death Certificate Filed District Number Register Number City, Town or Village Argyle S^) 5O 3? ❑Burial Date Cemetery or Crematory October 31, 2017 Pine View Crematory ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z ❑ Removal and/or Held 0and/or Address Hold Date Point of a. n Transportation Shipment Vi by Common Destination Cl Carrier Date Cemetery Address ❑ Disinterment ❑ Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M. B. Kilmer Funeral Home- FE 01079 Address 82 Broadway, Fort Edward NY 12828 Name of Funeral Firm Making Disposition or to Whom I— Remains are Shipped, If Other than Above 2 Address W Permission is hereby granted to dispose of the human re ains described above as indicated. Date Issued /b/3 t ) 1 7 Registrar of Vital Statistics (signature) District Number 5 '1 j Q Place aNtilt. , kit./ I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 10/31/2017 Place of Disposition Quaker Road Queensbury,NY 12804 (address) W (section) /� (lot nu per) (grave number) Name of Sexton or Person in Charge of Premises G 1 twit- z ' (please print) W Signature Title moJt (over) DOH-1555 (02/2004)