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Randles, Eleanor Louise 2�3 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Eleanor Louise Randles Female Date of Death Age If Veteran of U.S.Armed Forces, 03/25/2020 99 Years War or Dates F Place of Death Hospital,Institution or WCity,Town or Village Fort Edward Town Street Address 325 Broadway,The Oaks 11,Fort Edward Town,New York 12828 'p Mannerof Death ©Natural Cause Accident Homicide Suicide Undetermined Pending V Circumstances Investigation Q Medical Certifier Name Title Jamie Bovair NP Address 325 Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 23 Burial Date Cemetery,Crematory or Facility Name 03/27/2020 Pine View Crematory Entombment Address X❑Cremation Queensbury Town,New York Donation zRemoval Date Place Removed and/or and/or Held ~ Hold Address O a Date Point of CA ElTransportation p by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address Ej Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077 Address 123 Main St,Argyle,New York 12809 Name of Funeral Firm Making Disposition or to Whom II— Remains are Shipped,If Other than Above Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/27/2020 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: H z Date of Disposition 3 Zp Place of Disposition W 2 (address) W N (section) (lot nu / (grave number) GName of Sexton or Person in Charge Premises s tr Z /please print) W Signature Title DOH-t555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 013479 Receipt Human remains of ►i delivered on � �''= � , 20 1 Pine:View Cemetery /Representinmog"the pdneral home married on burial permit Official Funeral Directors Reg.or License# r;