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Caldwell, Krista NEW YORK STATE DEPARTMENT OF HEALTH t 47 yb-t, Vital Records Section = urial - Transit Permit Name First Middle 11, , ast Sex Krista Marie =idwell Female Date of Death Age If Veter- _ . . Armed Forces, December 9, 2017 47 War or pates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address 92 Warren Street Manner of DeathL. Natural Cause Accident ❑ Homicide ❑ Suicide riUndetermined X❑ Pending U Circumstances Investigation 111 Medical Certifier Name Title 0 Paul F. Bachman, ME Address Warrensburg, NY 12885 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5 60 I i,3 A ,I2 Burial Date Cemetery or Crematory December 15, 2017 Pine View Crematory 0 Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed zriRemoval and/or Held and/or Address Hold 0 Date Point of gElTransportation Shipment by Common Destination a. Carrier IIIDisinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M.B. Kilmer Funeral Home-SGF 01078 Address 136 Main Street, South Glens Falls NY 12803 E; Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address latiX Permission is hereby granted to dispose of the human remains described above as indicated. --- Date Issued (2/ t 3 t z ( ] Registrar of Vital Statistics LA-)c t,. �-y.� `,n,�� (signatu ) District Number 5O( Place 6(.9x%S 105, N Y I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 12/15/2017 Place of Disposition Quaker Road Queensbury,NY 12804 (address) 0 0 (section) lot number) (grave number) Gil Name of Sexton or Person in Charge of Pre ises ��Aehil (p ase print) W Signature a Title l i(- (over) DOH-1555 (02/2004)