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Ryan, Colleen V UGH INcI.,viva Jcl.uvII LaUl IAI ' 114211011. 1'C1 11111 Name First Last Sex Colleen Marie Ryan Female - Date of Death Age If Veteran of U.S.Armed Forces, 01/05/2018 58 Years War or Dates Place of Death Hospital, Institution or q City, Town or Village Glens Fall Street Address Glens Falls Hospital Manner of Death©Natural use Accident Homicide 0 Suicide Undetermined Pending Circumstances Investigation Medical Certifier Name Title ' Paul Bachman MD Address ti$ 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number * City, Town or Village Glens Falls 5601 9 ❑Burial Date Cemetery or Crematory 01/08/2018 Pine View Crematory ❑Entombment Address ®Cremation Queensbury Town, New York Date Place Removed ❑Removal and/or Held ,.w., and/or I L. Address Hold Date Point of Transportation Shipment by Common Destination Carrier • Disinterment Date Cemetery Address • ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 A• ddress • 136 Main St,S Glens Falls,New York 12803 N• ame of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address P• ermission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/08/2018 Registrar of Vital Statistics gO6ertACurtis(E(ectronica1tySigned) (signature) District Number 5601 Place Glens Falls, New York frtr certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition f/r/o)jg Place of Disposition e ' (address) (section) /It number) (grave number) i .H Name of Sexton or Person in Charge of Premise rz rL " * Q, (plea-4 print) Signature LJ� T Title � t#int. (over) DOH-1555 (02/2004)