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Tatsey, Carol Ann -7 -78 NEWYORK STATE DEPARTMENT OF HEALTH BUrlal - Transit Permit Bureau of Vital Records Name First Middle Last Sex Carol Ann Tatsey Female Date of Death Age If Veteran of U.S.Armed Forces, 11/21/2019 78 Years War or Dates Place of Death Hospital,Institution or W' City,Town or Village Glens Falls Street Address Glens Falls Hospital C Manner of Death © Natural Cause Accident Homicide 1:1Suicide Undetermined Pending (Wj Circumstances Investigation QW Medical Certifier Name Title Michael Adams MD Address 1448 Route 9,Fort Edward Town,New York 12828 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 502 Burial Date Cemetery,Crematory or Facility Name 11/25/2019 Pine View Crematory Entombment Address 0 Cremation Queensbury Town,New York ❑Donation 0z ❑Removal Date Place Removed and/or and/or Held Cl) Hold Address O CO)C FITransportation Date Point of p by Common Shipment 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 IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/22/2019 Registrar of Vital Statistics �RqbertAndrew Curtis((ECectronicaCCy Signed) (signature/ District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: LIJ Date of Disposition tt 2S�) Place of Disposition w 4AVr1v, 2 (address/ W M (section) 1A, (lotnumber) (grave number/ aName of Sexton or Person in Charge of Premises z (pl ase print/ lU Signature ._.�- Title DO H-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2bT ` 01310- Receipt Human remains of delivered on ; , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#