Jordan, Jody# 605—
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last --T-Sex
Jody Lynn Jordan
Female
Date of Death
Age
If Veteran of U.S. Armed Forces,
09/06/2019
49 Years
War or Dates
F—
Place of Death
Hospital, Institution or
Z
City, Town or Village Argyle Town
Street Address 801 Coach Road, Argyle Town, New York 12809
W
G
Natural Cause Accident Homicide ❑ Suicide Undetermined Pending
Manner of Death g
�
Circumstances Investigation
W
Medical Certifier Name Title
0
Robert Lemieux Coroner
Address
415 Lower Main St., Hudson Falls, New York 12839
Death Certificate Filed
District Number
Register Number
City, Town or Village Argyle
5750
37
Burial
Date
Cemetery, Crematory or Facility Name
09/11/2019
Pine View Crematory
Entombment
Address
51 Cremation
Queensbury Town, New York
Donation
Date Place Removed
Removal
0
and/or and/or Held
P
Hold Address
N
O
d
N
Date Point of
Transportation
Q
Shipment
by Common
Carrier Destination
Disinterment
Date
Cemetery Address
1011einterment
Date
Cemetery Address
Permit Issued to
Registration Number
Name of Funeral Home M B Kilmer Funeral Home - Argyle
01077
Address
123 Main St, Argyle, New York 12809
Name of Funeral Firm Making Disposition or to Whom
F
Remains are Shipped, If Other than Above
Address
cc
W
I'
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/1112019 Registrar of Vital Statistics Ski ym,-krrnon(Elrccron,-iadysrgr-a)
(signature/
District Number 5750 Place Argyle, New York
I certify thatthe remains of the decedent identified above were disposed of in accordance with this permit on:
H
Z
Date of Disposition ► ,( Place of Disposition r+�-
W
/address/
W
N
/sedbn/ /lot number/ /gra ve number/
Q
8
Name of Sexton or Person in Charge of Premises �1
/pl se print
Z
W
Signature Title M
DOH-1555 (07/18) p 1 of 2
Public Health Law Sec. 4145(2b)
u 12 5 3 1
Receipt
Hunxan-ins Of delivered on 20
Pine View Cemetery Representing the funeral home named on burial peOfficial Funeral Directors Reg. or License #