Cowden, Jean NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Jean Natalie Cowden Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/14/2018 90 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Ballston Spa Village Street Address Saratoga Center for Rehab and Skilled Nursing
Manner of Death X❑Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Vina Patel MD
Address
149 Ballston Ave,Ballston Spa Village,New York 12020
Death Certificate Filed District Number Register Number
City, Town or Village Ballston Spa Village 4520 5
❑Burial Date Cemetery or Crematory
01/18/2018 Pine View Crematory
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
❑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-South Glens Falls 01078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/18/2018 Registrar of Vital Statistics Teri Lee OConnor(E(ectronica1TySigned)
(signature)
District Number 4520 Place Ballston Spa 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 / "�`,-/ Place of Disposition /;y1(U
(address)
(section) (lot numb,—) (grave number)
Name of Sexton or so in Charge of Premises �w I u� �
(please print /
Signature Title ' � �—
(over)
DOH-1555 (02/2004)