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Symack, Thomas Kevin � g8 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Thomas Kevin Symack Male Date of Death Age If Veteran of U.S.Armed Forces, 01/27/2020 59 Years War or Dates I- Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W Cy Manner of Death © Natural Cause Accident 1:1Homicide Suicide Undetermined Pending W Circumstances Investigation WMedical Certifier Name Title William Cleaver MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 44 Burial Date Cemetery,Crematory or Facility Name 01/28/2020 Pine View Crematory Entombment Address RI Cremation Queensbury Town,New York Donation z Removal Date Place Removed and/or and/or Held t- Hold Address O G- Date Point of N Transportation 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 E— Remains are Shipped,If Other than Above Address W (L Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/27/2020 Registrar of Vital Statistics 2i9bertAndrew Curtis(ElectronicallySigned) (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 Z Date of Disposition 179*1 zo Place of Disposition ,,i V .ljo rt� 2LLJ (address/ W N (section) (lot number) (grave number) 93 Name of Sexton or Person in Charge of Premises (please print/Z LU Signature Title M 'L DOH-t555( 7/ )o 18 P t of 2 *13 Public Health Law Sec. 4145(2b) J 13 2 8 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#