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Pierce, Elizabeth NEW YORK STATE DEPARTMENT OF HEALTH,! 1 it c 3 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Elizabeth B. Pierce Female Date of Death Age If Veteran of U.S. Armed Forces, ' January 13, 2018 98 War or Dates Place of Death Hospital, Institution or City, Town or Village Fort Edward Street Address 16 Cooper Street Manner of Deathm liu Natural Cause D Accident El Homicide 0 Suicide El Undetermined ri Pending Circumstances Investigation Medical Certifier Name Title Patricia Auer, Address 316 Carey Road Queensbury, NY 12804 Death Certificate Filed District Numb Register_Number City, Town or Village Fort Edward ,i-11. 5 oL ❑Burial Date Cemetery or Crematory January 16, 2018 Pine View Crematory Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed • Removal and/or Held • and/or Address Hold Date Point of ❑Transportation Shipment by Common Destination �a Carrier 0 Disinterment Date Cemetery Address 0 Reinterment Date Cemetery Address Permit Issued to Registration Number rt Name of Funeral Home M.B. Kilmer Funeral Home-SGF 01078 4-44 Address 136 Main Street, South Glens Falls NY 12803 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is h reb granted to dispose of the humane 'ns describ d a ve as 'ndicated. Date Issued Registrar of Vital Statistics (signature) r District Number 615J Place /(}7,(}n �6 /-0-1_76 Erdwt✓c/lL1 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: • 4 Date of Disposition 01/16/2018 Place of Disposition Quaker Road Queensbury,NY 12804 (address) ty (section) / lot number) (grave number) Name of Sexton or Person in Charge of Pr mises lfi S'`^v (phase print) Signature Title l"ilk- (over) DOH-1555 (02/2004)