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Washburn, Violet (Viola) Ruth NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Violet Ruth Washburn Female Date of Death Age If Veteran of U.S.Armed Forces, 05/13/2020 91 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 © Natural Cause Accident 1:1Homicide Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title 0 Wendy Steinhacker PA Address 152 Sherman Ave,Queensbury Town,New York 12801 Death Certificate Filed District Number Register Number City,Town orViUage Queensbury 5657 103 R1 Burial Date Cemetery,Crematory or Facility Name 05/18/2020 Pine View Cemetery Entombment Address Cremation Queensbury Town,New York ❑Donation Z Removal Date Place Removed O and/or Held and/or N Hold Address O a Date Point of N Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address EjReinterment 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 Other than Above Address it W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/14/2020 Registrar of Vital Statistics CaroCineJTii(Cegarde Barber(ECectronicaCCySigned) (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: H WDate of Disposition 5/1 8/2 0 2 0 Place of Disposition 21 Quaker Rd. Queensbury, NY 12804 W (address) ul Horicon 12 B 2 CO) (section/ (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises Connie Goedert Superintendent Z (please print) W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) _ _ 010332 Receipt l Human remains of delivered on , 20 r Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#� ' - WASHBURN NAME Viola Washburn Age: 91 Lot Owner: Viola Washburn Lot# Horicon 12 B Grave# 2 Case: Concrete Died: Interred: 5/13/2020 5/18/2020 Funeral Home: M.B. Kolmer Cemetery: Pine View