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Manero, Janice Meredith f J - l NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records ` Name First Middle Last Sex Janice Meredith Manero Female Date of Death Age If Veteran of U.S.Armed Forces, 05/02/2020 91 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Moreau Town Street Address 13 Castle Road,Moreau Town, New York 12803 a Manner of Death ©Natural Cause Accident �Homicide �Suicide �Undetermined �Pending V Circumstances Investigation G Medical Certifier Name Title Mark Quaresima MD Address 9 Carey Road,Queensbury Town, New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Moreau 4562 22 Burial Date Cemetery,Crematory or Facility Name 05/04/2020 Pine View Crematory Entombment Address Cremation Queensbury Town, New York Donation Z Date Place Removed 0 Removal and/or and/or Held F t/j Hold Address O IL N ElTransportation Date Point of 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 N Remains are Shipped,If Other than Above Address W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/04/2020 Registrar of Vital Statistics Leeann Mc cabe(Electronically Signed) (signature) District Number 4562 Place Moreau, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 2 Date of Disposition Zr1 LO Place of Disposition !—n a W 2 (address) W M (section) �� (lot number) (grave number) gName of Sexton or Person in rg Premises L✓ c C.�t,m u-t,-/— (please print) W Signature `' Title DOH-1555(07/18)p 1 of 2 1 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20_ Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#