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Rumrill, Sarah Lynn
NEW YORKSTATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name first Middle Last Sex Sarah Lynn Rumrill Female Date of Death Age If Veteran of U.S.Armed Forces, 01/14/2020 43 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Village Street Address 38 Mechanic St, Fort Edward Village, New York 12828 LU J3 Manner of Death Undetermined Pending © Natural Cause Accident ❑Homicide Ej Suicide g W Circumstances Investigation W Medical Certifier Name Title Jennifer Stratton MD Address 9 Carey Road,Queensbury Town, New York 12804 Death Certificate Filed District Number Register Number City,Town or Villa a Fort Edward 5755 5 Burial Date Cemetery,Crematory or Facility Name 01/16/2020 Pine View Crematory Entombment Address FKCremation Queensbury Town,New York Donation Oz Removal Date Place Removed and/or and/or Held N Hold Address O IL Date Point of U) 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 Address 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 Aimee Wahoney(ECectronicallySigned) (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: t— Z Date of Disposition II I-) (Zo Place of Disposition W 2 (address) W O (section) Aot number/ (grave number) Name of Sexton or Person in ha rge of Pr ises di-I Z lease print// 11J Signature Title DOH-1555(o7/18)p 1 of 2 1w Public Health Law Sec. 4145(2b) ` ^' 0 3 2 5 0 Receipt Human remains of °..' r- delivered on , ' r, !' '' , 20 Pine View Cemetery Representing the funeral home named on burial hermit Official Funeral Directors Reg.or License#"