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Putney, MichaelktD N EW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial -Transit Permit Name First Middle Last Sex Michael Lee Putney Male Date of Death Age If Veteran of U.S. Armed Forces, 10/06/2019 75 Years War or Dates 1961-1981 Place of Death Hospital, Institution or W City, Town or Village Glens Falls Street Address Glens Falls Hospital 0 Manner of Death ©Natural Cause � Accident 0 Homicide � Suicide � Undetermined � Pending W W Circumstances Investigation Medical Certifier Name Title William Cleaver MD Address 100 Park St, Glens Falls, New York 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 433 Burial Date Cemetery, Crematory or Facility Name 10/09/2019 Pine View Crematory Entombment 0 Cremation Address Queensbury Town, New York Donation 0 Removal Date Place Removed and/or and/or Held ~ Hold Address O CL Date Point of 0) p ❑ Transportation 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 IH Remains are Shipped, If Other than Above Address Uj a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/08/2019 Registrar of Vital Statistics q;�96ert Andrew Curtis (ECectronicaCCy 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: H W n�I ` Date of Disposition 10 j5 15 Place of Disposition V• �. t4r"",—tor�+� LU (address) W N (section) lot number) (grave number) 13 Name of Sexton or Person in Charge of Premises r.t r Z (please print) W Signature ( •C Title DOH-1555 (07/18) p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of 1 delivered on - ; , 20 ' '{ Pine View Cemetery Representing the IVneral home named on burial permit Official Funeral Directors Reg. or License #