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Rounds, Kathryn E.
41 1$t NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kathryn E.Rounds Female Date of Death Age If Veteran of U.S.Armed Forces, 02/29/2020 52 Years War or Dates (F— Place of Death Hospital,Institution or W City,Town or Village Queensbury Town Street Address 18F Sage Drive,Queensbury Town, New York 12804 7 ,p Manner of Death © Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation G Medical Certifier Name Title Aqeel Gillani MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 132 Burial Date Cemetery,Crematory or Facility Name 03/03/2020 Pine View Crematory Entombment Address 0 Cremation Queensbury Town,New York Donation 0 Removal Date Place Removed and/or and/or Held N Hold Address O d 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 Alexander Baker Funeral Home 00037 Address 3809 Main St;Warrensburg, New York 12885 Name of Funeral Firm Making Disposition or to Whom �— 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 03/02/2020 Registrar of Vital Statistics CarohneMifdegarde Barber(ECectronicadySigned (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W n Date of Disposition 3 3 Zp Place of Disposition 4 L (address) W CO) Ix (section) (!ot nu / (grave number) 8 Name of Sexton or Person in Charge of Premises Ir Z Please print) W Signature Title &/ f DO H-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 01, 3382 Receipt Human remains of delivered on , 20 Pine View Cemetery Represenfing the funera,Home named on burial permit Official Funeral Directors Reg.or License#