Dow, Anna May ' 3LO
NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Anna May Dow Female
Date of Death Age If Veteran of U.S.Armed Forces,
04/15/2020 92 Years War or Dates
F. Place of Death Hospital,Institution or
WCity,Town or Village Queensbury Town Street Address The Stanton Nursing And Rehabilitation Centre
p Mannerof Death ❑X Natural Cause ❑Accident Homicide Suicide ❑Undetermined ❑Pending
Circumstances Investigation
WMedical Certifier Name Title
Wendy Steinhacker PA
Address
152 Sherman Ave,Queensbury Town,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 72
❑Burial Date Cemetery,Crematory or Facility Name
04/17/2020 Pine View Crematory
Entombment Address
MCremation Queensbury Town,New York
❑Donation
Z Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
O
Ill. Date Point of
UN❑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-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 Otherthan Above
Address
cc
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/16/2020 Registrar of Vital Statistics CarnCtnexfdegarde Barver(ElectronicallySoned)
(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:'�L,
Date of Disposition I In -rb Place of DispositionUj
Uj (address/
W
N (section/ (i, number/ (grave number)
IM s
8 Name of Sexton or Person in Cha a of Premis
Z / (lease print/ 0
W Signature �,�f Title `
DOH-1555(o7/18)p t of 2
Public Health Law Sec. 4145(2b) 01 1 J. 5 5 E
Receipt
Human remains of delivered on20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#