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Karides, Allegra Marie t s3 g NEW YORKSTATE DEPARTMENT OF HEALTH �-� Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Allegra Marie Karides Female Date of Death Age If Veteran of U.S.Armed Forces, 05/04/2020 82 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation pManner of Death ©Natural Cause Accident Homicide Suicide ❑Undetermined Pending V Circumstances Investigation WW Medical Certifier Name Title Kenneth France MD Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 205 Burial Date Cemetery,Crematory or Facility Name 05/07/2020 Pine View Crematory Entombment Address X❑Cremation Queensbury Town,New York ❑Donation Z ❑Removal Date Place Removed and/or and/or Held ~ Hold Address t%3 0 ❑Transportation Date Point of 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 E- Remains are Shipped,If Other than Above Address Q W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/07/2020 Registrar of Vital Statistics Robert Andrew Curtis(Electronically Signed) /signature/ District Number 5601 Place Glens Falls, 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 Place of Disposition /address/ W N (section/ /!ot In mber/ /gra ve number/ Q ` d Name of Sexton or Person in Charge of Premises /plea print/ IL) Signature Z= Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt f Human remains of i delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# - 1