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Somers, Tammy NEW YORK STATE DEPARTMENT OF HEALTH -of Vital Records Section Burial - Transit Permit Name First Middle Last Sex 44: Tammy Jane Somers Female Date of Death Age If Veteran of U.S. Armed Forces, ,` August 24, 2018 54 War or Dates Place of Death Hospital, Institution or ut City, Town or Village Fort Edward Street Address 190 Broadway Manner of Death ❑ Natural Cause ❑ Accident ❑ Homicide ❑ Suicide 0 Undetermined X❑ Pending Circumstances Investigation Medical Certifier Name Title 0 r Robert Lemieux, Address 219 Pope Hill Road Argyle, NY 12809 Death Certificate Filed District Num r Register N er City, Town or Village Fort Edward t 77I) ❑Burial Date Cemetery or Crematory August 27, 2018 Pine View Crematory ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed zRemoval 0 ❑ and/or Held and/or Address p Hold _ O Date Point of ▪ ❑Transportation Shipment 49 by Common Destination O Carrier Date Cemetery Address ❑ Disinterment Date Cemetery Address ❑ Reinterment Permit Issued to Registration Number Name of Funeral Home M. B. Kilmer Funeral Home- FE 01079 Address 82 Broadway, Fort Edward NY 12828 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address ry' Permission is h reb granted to dispose of the human r 'ns describ d ab ve •s i y•icated. Date Issued 7 g Registrar of Vital Statistics , (--' (sign ture) / District Number .4765 Place.-- lacetii mt- Eau I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 08/27/2018 Place of Disposition Quaker Road Queensbury,NY 12804 „ (address) 141 (`E (section) /, (lot number) (grave number) Name of Sexton or Person in Charge f Premises ` �i �i' ,S�•"tiii /f� (ple se print) G✓(Signature Title A L (over) DOH-1555 (02/2004)