Bolster, Elva z
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Elva Gloria Bolster Female
Date of Death Age If Veteran of U.S. Armed Forces,
02/23/2018 90 Years War or Dates
Place of Death Hospital, Institution or
It City, Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death Nji Natural Cause 0 Accident 0 Homicide 0 Suicide ri Undetermined ri Pending
Circumstances Investigation
UI
1t Medical Certifier Name Title
a Kara Comins PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 105
®Burial Date Cemetery or Crematory
03/01/2018 Pine View Cemetery
is❑Entombment Address
r,';OCremation Queensbury Town, New York
Date Place Removed
QRemoval and/or Held
o and/or Address
Hold
VI
Date Point of
Q Transportation Shipment
G by Common Destination
Carrier
Disinterment Date ' Cemetery Address
Q Renterment 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
tz Remains are Shipped, If Other than Above
Address
fill. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/26/2018 Registrar of Vital Statistics RpbertA Curtis(ECectronicaffySigned)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above we disposed of in cordance with this permit on:
ri
Date of Disposition ((zo(g) Place of Disposition Zl (� �. tt(address)
olrl4W L. 3 Z
(s on) II (lot number) (grave number)
Name of Sexton or Person in Charge of Premises
L.
�p ( leas p nt),
114 Signature I^-• d Titl
(over)
DOH-1555(02/2004)