Loading...
Elms, Penelope jib NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle, Last Sex Penelope Ann Elms Female It 0 Date of Death Age If Veteran of U.S.Armed Forces, 02/18/2018 66 Years War or Dates 1970-1994 Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause 0 Accident Ei Homicide Suicide riUndetermined ri Pending 6e Circumstances Investigation Medical Certifier Name Title 0Dean Reali DO :. Address ws. 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 95 kV,r—i❑Burial Date Cemetery or Crematory 02/23/2018 Pine View Crematory QEntombment1,0 -Address ®Cremation Queensbury Town, New York, - .., Date Place Removed .' ❑Removal and/or Held and/or Address Hold ' Date iPoint of Q Transportation Shipment EThi by Common Destination r Carrier F Date Cemetery Address : Disinterment Q Reinterment Date Cemetery Address 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 ior Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/20/2018 Registrar of Vital Statistics gyGert A Curtis t ErectroniraCCy Signer a, (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 Zin(it Place of Disposition f uAIv 4w,4.,... (address) 1 L; (section) it (lot number)' (grave number) ilf p Name of Sexton or Person i Charge of Pr mises .4 .. 2 C� ( ease print) Signature __ ` .,. Title -- (over) DOH-1555 (02/2004)