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Baker,Kimberly Ann t _ _ tl qq NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kimberly Ann Baker Female Date of Death Age If Veteran of U.S.Armed Forces, 04/23/2020 41 Years War or Dates II.- Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address 230 West Avenue,Saratoga Springs, New York 12866 WManner of Death ❑ Natural Cause ❑Accident El Homicide ❑Suicide Undetermined ©Pending ul Circumstances Investigation W Medical Certifier Name Title 0 David DeCelle Coroner Address 40 McMaster Street,Ballston Spa,New York 12020 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 254 Burial Date Cemetery,Crematory or Facility Name 05/02/2020 Pine View Crematory Entombment Address ECremation Queensbury,New York Donation Z Removal Date Place Removed P and/or and/or Held H tt Hold Address 0 IL Date Point of V) Transportation Gt 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 II_, 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 04/28/2020 Registrar of Vital Statistics yohn Eaufftanck(ECectronicaCCy Signed) /signature) District Number 4501 Place Saratoga Springs, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition Z ZoPlace of Disposition �„L c lu (address) ul 0 (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premises (ple a print) ill Signature Title" DO H-1555(o7/18)p 1 of 2 F. Public Health Law Sec. 4145(2b)' 013 S; Receipt i Human remains of delivered on , 20— Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#