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Powers, Anne - ACfo NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Anne Frances Powers Female Date of Death Age If Veteran of U.S. Armed Forces, 07/24/2018 81 Years War or Dates Place of Death Hospital, Institution or k. City, Town Or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc Manner of Death©Natural Cause E Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title F. Philip Gara MD Address 319 Broadway,Fort Edward Town,New York 12828 Death Certificate Filed District Number Register Number IA City, Town or Village Fort Edward 5755 37 TV ❑Burial Date Cemetery or Crematory 07/30/2018 Pine View Crematory , ['Entombment Address ®Cremation Queensbury Town, New York Date Place Removed ❑Removal and/or Held and/or Address Hold Iv Date Point of 1--4.r ri❑Transportation Shipment by Common Destination Carrier ❑Disinterment Date Cemetery Address ams ❑Reinterment Date Cemetery Address 44, Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom Li Remains are Shipped, If Other than Above Address s Permission is hereby granted to dispose of the human remains described above as indicated. kz- Date Issued 07/25/2018 Registrar of Vital Statistics Aimee Makoney Octronica(CySigned) 6. (signature) District Number 5755 Place Fort Edward, New York oU I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition $/I IIg Place of Disposition R. ti-d„-v-- (address) Al (section) (lot n��ber) (grave number) Name of Sexton or Person in Charge of Premises / 414.- S *41AM (please pr t) ti a 4 Signature Title ft-'"M TIt (over) DOH-1555(02/2004)