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Hinton, Betty Marie NEW YORKSTATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial -``Transit Permit Name First Middle Last Sex Betty Marie Hinton Female Date of Death Age If Veteran of U.S.Armed Forces, 12/19/2019 74 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital p Mannerof Death © Natural Cause Accident 1:1Homicide ❑Suicide Undetermined Pending W Circumstances Investigation U �LLJ Medical Certifier Name Title Jeremy Di Bari MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 544 Burial Date Cemetery,Crematory or Facility Name 12/23/2019 Pine View Crematory Entombment MV Address low 1 Cremation Queensbury Town,New York Donation 0 Removal Date Place Removed and/or and/or Held N Hold Address O N ❑Transportation Date Point of 1 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 t- 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 12/23/2019 Registrar of Vital Statistics WgbertAndrew Curtis(ECectronicady 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: H W Date of Disposition Z-z4/_I Place of Disposition (address) W U) (section) (lot number) (grave number) Name of Sexton or P o in arge of Premises c Z (please print) W Signature Title 4 DOH-1555(07/18)P i of 2 Public Health Law Sec. 4145(2b) '19 13-1 7 5 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#