Gedney, Jane NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Jane Eleanor Gedney Female
Date of Death Age If Veteran of U.S. Armed Forces,
November 3, 2013 86 War or Dates
Place of Death Hospital, Institution or
In City, Town or Village Moreau Street Address 13 Primrose
W Manner of Death Natural Cause ❑ Accident ❑ Homicide El Suicide n Undetermined n Pending
LI Circumstances Investigation
W Medical Certifier Name Title
Aqeel A. Gillani, M.D. Dr.
Address
102 Park Street Glens Falls, NY 12801
Death Certificate Filed District,ilvber Register Nu b 6o
City, Town or Village Moreau (�j2 ._-? 3
Airq
®Burial Date Cemetery or Crematory
November 8, 2013 Pine View Cemetery
❑Entombment Address
❑Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
zElRemoval and/or Held
O and/or Address
Hold
Date Point of
Transportation Shipment
CO by Common Destination
O Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home 01078
Address
136 Main Street, South Glens Falls NY 12803
Name of Funeral Firm Making Disposition or to Whom
t Remains are Shipped, If Other than Above
2 Address
W'
I' Permission is hereby granted to dispose of the human re "ns described above as in icated.
Date Issued MG /13 Registrar of Vital Statistics j Aj14.4. ..
(signature) LLLELY
District Number 45/D2 Place,35i1 iCE: ^J0LDs f D. 1-007- ETSWA/Z Al j i 2f 23
I certify that the remains of the decedent identified above were disposed of in qccordanoe with this permit on:
pi 1't.e.V .cu-) f.Pr-cr
Date of Disposition 11/08/2013 Place of Disposition Quaker Road Queensbury,NY 12804
(address)W 0 /
C" (sect n) /' (lot number) (grave number)
0" Name of Se n or Person in Charge of Premises Co G2�e. .,L. C_/)'oh-Glett�
`� (please print)
W Signatur(�/// a dam.. -e Titl
( (over)
DOH-1555 (02/2004)