Flewelling, Thelma NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Thelma Grace Flewelling Female
Date of Death Age If Veteran of U.S. Armed Forces,
06/21/2018 85 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Granville Village Street Address Indian River Rehabilitation And Nursing Center
Manner of Death X Natural Cause I Accident 1 I Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Thomas Kandora MD
4‘ Address
17 Madison St,Granville Village,New York 12832
Death Certificate Filed District Number Register Number
City, Town or Village Granville Village 5725 28
Burial Date Cemetery or Crematory
— 06/25/2018 Pine View Crematory
Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
Removal and/or Held
and/or
Address
Hold
Date Point of
1 Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077
Address
123 Main St,Argyle,New York 12809
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/22/2018 Registrar of Vital Statistics Ward"Weberts(EfectronicafTySigned)
(signature)
District Number 5725 Place Granville Village, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition (,f il,lt8 Place of Disposition �t �twys f or.—.,
(address)
(section) liot number) (grave number)
Name of Sexton or Person in Charge of Premises %,�tnl_number)
(please print)
7-- d 2
Signature Title agAitrvn
(over)
DOH-1555 (02/2004)