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Ormsby, Joyce Name First _ Mice Last Sex Joyce Ann Ormsby Female Date of Death Age If Veteran of U.S.Armed Forces, 08/02/2018 67 Years , War or Dates le Place of Death Hospital, Institution or City, Town or Village Albany Street Address St Peters Hospital C1 Manner of Death©Natural Cause 0 Accident 0 Homicide El Suicide tri i Undetermined ❑Pending irk Circumstances Investigation C. w Medical Certifier Name Title 0 Jenna Patterson NP Address 315 S Manning Blvd,Albany,New York 12208 Death Certificate Filed / District Number Register Number City, Town or Village Albany 0101 1705 Burial Date Cemetery or Crematory 08/07/2018 Pine View Crematory ❑Entombment Address ®Cremation Queensbury Town, New York Date Place Removed z fl Removal and/or Held and/or Address Hold Vi Date Point of 011*Q Transportation Shipment a by Common Destination Carrier Q Disinterment Date r ,ietery Address n Renterment Date ,emetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fot Edward 01079 Address I 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom 1 Remains are Shipped, If Other than Above Address w EL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/06/2018 Registrar of Vital Statistics DaniefCeS yiliespie(EfectronicaffySigned) (signature) District Number 0101 Place Albany, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 2 1 8 I f pDisposition � . ., et -tom... ; Date of Disposition Place of g (,� W (adaess) CO tit °� umber) c (grave number) Name of Sexton or Person in Charge of Premises (section) �`�r►,�p�. _S- e R+AIM ;� a e E. /�/ g (please t�i�) Signature al4 Title C111012 (over) DOH-1555(02/2004)