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Saville, Burt Alfred
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last $eX Burt Alfred Saville Male Date of Death Age If Veteran of U.S.Armed Forces, 03/14/2020 88 Years War or Dates Place of Death Hospital,Institution or City,Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title Matthew Loftus PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Villa a Glens Falls 5601 122 ❑Burial Date Cemetery,Crematory or Facility Name ❑ 03/16/2020 Pine View Crematory Entombment Address f Cremation Queensbury Town,New York ❑Donation ❑Removal Date Place Removed and/or and/or Held Hold Address ❑Transportation Date Point of by Common Shipment farrier k Destination s� i. ❑Disinterment Date Cemetery Address tK:•,_ "x ❑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 Remains are Shipped,If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. 03/16/2020 6ert Date Issued Registrar of Vital Statistics �9 Arafrew Curtis(ECectronicaCCy Signed F (signature) 0 r 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: Date of Disposition c) Place of Disposition , C 6Aq�'C (address) (section) Aotnumber/ (grave number) Name of Sexton or Person in Charge of Premises u-"" y BLS (Please print) Signature 4& ow Title DO H-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) } �. ' Receipt Human remains of ;R ", ;� delivered on ;' t" , 20- Pine Vied+Cemetery Representing-the funeral home named on burial permit Official Funeral Directors Reg.or License# f.