Pratt, Evelyn Reese NEW YORKSTATE DEPARTMENT OF HEALTH Burlal - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Evelyn Reese Pratt Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/25/2020 70 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Kingsbury Town Street Address 131 Myrtle Avenue, Kingsbury Town, New York 12839
V Mannerof Death �Natural Cause Accident Homicide ❑Suicide Undetermined Pending
Circumstances Investigation
QW 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 Kingsbury Town 5762 8
Burial Date Cemetery,Crematory or Facility Name
03/27/2020 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
Z Removal Date Place Removed and/or and/or Held
~ Hold Address
N
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-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
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/27/2020 Registrar of Vital Statistics Cmhfja.4 Bardirt(EYectronica1T Signed
(sirature/
District Number 5762 Place Kingsbury Town, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 3p I io Place of Disposition
(address/
W
m
(section/ I,,
otnumber/ r /grave number/Name of Sexton or Person in Charge of P mises J
Z (Plea print/
W Signature Title
DOH-1555(o7/18)p 1 of 2
Public Health Law Sec. 4145(2bY' 013460
Receipt
Human remains of ! r' r a - delivered on; i, , , 20T
Pine View Cemetery Representing`t'lie funeral home namKI on burial permit
Official Funeral Directors Reg.or License# r`