Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Brown, Janet Leigh
-7q3 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Janet Leigh Brown Female Date of Death Age If Veteran of U.S.Armed Forces, 11/07/2019 69 Years War or Dates II— Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc tL Manner of Death Undetermined Pending W © Natural Cause ❑Accident Homicide Suicide g Circumstances Investigation W Medical Certifier Name Title 0 Carrie Miron PA Address 319 Broadway,Fort Edward Town, New York 12828 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 91 Burial Date Cemetery,Crematory or Facility Name 11/11/2019 Pine View Crematory Entombment Address WICremation Queensbury Town, New York Donation 0 Removal Date Place Removed and/or and/or Held ~ Hold Address N O �. Date Point of to Transportation Shipment Q by Common Carrier Destination ❑Disinterment Date Cemetery Address 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 Remains are Shipped,If Other than Above '�• Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/08/2019 Registrar of Vital Statistics Aimee Mahoney(Electronically Signed) (signature) District Number 5755 Place Fort Edward, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition Place of Disposition ,4 ,✓ C i+. (w (address) W _ (section) (tot number/ (grave number) Name of Sexton or Person in Charge of Premises — f. Z D (p/ea a print) W Signature `,/" Title AWA 10 DOH-1555(o7/18)p t of 2 Public Health Law Sec. 4145(2b) 013068 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#