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Arcuri, SophieN EW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records bI Burial - Transit Permit Name First Middle Last Sex Sophie Arcuri Female Date of Death Age If Veteran of U.S. Armed Forces, 10/18/2019 89 Years War or Dates �.,. Place of Death Hospital, Institution or Z City, Town or Village Wilton Town Street Address 16 Melanie Drive, Wilton Town, New York 12866 W W Manner of Death Undetermined Pending © Natural Cause Accident Homicide Suicide g U Circumstances Investigation W Medical Certifier Name Title 0 Marianne Mustafa MD Address 6 Medical Park Drive 208, Malta Town, New York 12020 Death Certificate Filed District Number Register Number City, Town or Village Gansevoort 4569 44 Burial Date Cemetery, Crematory or Facility Name 10/23/2019 Pine View Crematory Entombment Address nCremation Queensbury Town, New York Donation Removal Date Place Removed 0 and/or and/or Held Hold Address N O a Date Point of N Q ❑ 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 Remains are Shipped, If Other than Above Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/23/2019 Registrar of Vital Statistics Susan Baldwin (Electronically Signed) (signature) District Number 4569 Place Gansevoort, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z ` Date of Disposition fo/1311�j Place of Disposition tMf✓i� �jt./�7�sv,� W (address) W (A (section) /J (/otnumber/ (grave number) O Name of Sexton or Person in Charge of Premises 6 �'� �� ''4jtt n (ptVase print/ W Signature Title 6/, DOH-1555 (o7/18) p 1 of 2 Public Health Law Sec. 4145(2b) 013018 Receipt t. Human remains of 4 x? delivered on f f`-- 20 Pine View Cemetery Representing the fu r ome named on burial permit Official Funeral Directors Reg. or License # �Z. =- ` i