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Meyer, Dorothy Viola
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Dorothy Viola Meyer Female Date of Death Age If Veteran of U.S.Armed Forces, 01/15/2020 91 Years War or Dates II.— Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital `p Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title Julian Marynczak PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 32 ❑Burial Date Cemetery,Crematory or Facility Name 01/16/2020 Pine View Crematory ❑Entomhment Address X❑Cremation Queensbury Town,New York ❑Donation Z Date Place Removed 0 ❑Removal and/or and/or Held H N Hold Address O d Date Point of ❑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-Fort Edward 01079 Address 82 Broadway,Fort Edward, New York 12828 Name of Funeral Firm Making Disposition or to Whom II-- Remains are Shipped,If Other than Above 2 Address cc W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/16/2020 Registrar of Vital Statistics (R96ertAiufrew Curtis(ECectronicallySigned) (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: Il— Z Date of Disposition Place of Disposition W 2 (address) W N cc (Section) (tot number) (grave number) SName of Sexton or Person in Charge of Premises (please print/Z LU Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 013252 Receipt Human remains ofrdefivefed on 20 Pine View Cemetery Representing the funeral home-named on,burjal-permit Official Funeral Directors Reg.or License#-