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Sanders, Peter James NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Peter James Sanders Male Date of Death Age If Veteran of U.S.Armed Forces, 02/12/2020 54 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village South Glens Falls Village Street Address 31 Baker Avenue,South Glens Falls Village,New York 12803 'p Mannerof Death © Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation U Title W Medical Certifier Name Ageel Gillani MD Address 100 Park St,Glens Falls, New York 12801 Death Certificate Filed District Number Register Number City,Town or Village South Glens Falls Village 4524 2 Burial Date Cemetery,Crematory or Facility Name 02/18/2020 Pine View Crematory Entombment Address XJ Cremation Queensbury Town,New York Donation Z Removal Date Place Removed and/or and/or Held ~ Hold Address t%3 dDate Point of 0 Transportation Shipment Q by Common 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 n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/18/2020 Registrar of Vital Statistics Shannon Kelleher(Electronically Signed) (Signature) District Number 4524 Place South Glens Falls Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H WDate of Disposition Z�IS to Place of Disposition /address) 2 W to /section) /lot number) (grave number) Q Name of Sexton or Person in Charge of Premises a � /pl se print/ z /./`�f :L W Signature ' Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 j-,J 3 4 4 Receipt Human remains of delivered on , M Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#