Palmer, Joel 4
NEW YORK STATE DEPARTMENT OF HEALTH Mj 8g
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Joel Ernest Palmer Male
Date of Death Age If Veteran of U.S. Armed Forces,
11/01/2018 78 Years War or Dates
I— Place of Death Hospital, Institution or
WCity, Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death 0 Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
W Circumstances Investigation
W Medical Certifier Name Title
G Jean Vanauken PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 515
❑Burial Date Cemetery or Crematory
11/02/2018 Pine View Crematory
['Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
OH ❑Removal and/or Held
and/or 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-Fort Edward 01079
Address
82 Broadway,Fort Edward,New York 12828
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
2 Address
LU
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/02/2018 Registrar of Vital Statistics Rp6ertA Curtis(Ecectronicary Signed)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z �
W Date of Disposition It/s I i g Place of Disposition '"�u"' 1-M4, 'OP!`..
2 (address)
LU
N
(section) 1J (lot num er) (grave number)
CI Name of Sexton or Person in Charge of Premises �^r. — ( 40
Z ( lease print)
W Signature /� Title till
(over)
DOH-1555 (02/2004)