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Jennings, Eleanor Pearl 0- 13� NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Eleanor Pearl Jennings Female Date of Death Age If Veteran of U.S.Armed Forces, 02/08/2020 88 Years War or Dates F Place of Death Hospital,Institution or WCity,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc p Manner of Death © Natural Cause Accident 1:1Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title Michael Miles MD Address 319 Broadway,Fort Edward Town,New York 12828 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 11 Burial Date Cemetery,Crematory or Facility Name 02/11/2020 Pine View Crematory Entombment Address ECremation Queensbury Town,New York Donation Z Removal Date Place Removed O and/or and/or Held ~ Hold Address O IL 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 Remains are Shipped,If Other than Above Address W I' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/11/2020 Registrar of Vital Statistics Aimee Mahoney(Electronically Signed) (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— W Date of Disposition Zltt I2b Place of Disposition ZL 6vro_ (address) W (section) ff (lot number/ (grave number) dName of Sexton or Person in Char of Premises h Z /lease print) W Signature Title ` DO H-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0133 �c Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#