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Bieibtrey, Linda NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Linda Anne Bleibtrey Female Date of Death Age If Veteran of U.S.Armed Forces, 09/25/2018 71 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title Scott Biasetti MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 457 0 Burial Date Cemetery or Crematory 09/26/2018 Pineview Crematory ['Entombment Address ®Cremation warren Date Place Removed ❑Removal and/or Held and/or Address Hold Date Point of Q Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address Q Renterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Jillson Funeral Home Inc 00885 Address 46 Williams Street,Whitehall Village,New York 12887 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 09/25/2018 Registrar of Vital Statistics Rp6ert)1 Curtis(E(ectronica((y 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: Date of Disposition gill(It Place of Disposition (address) (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premises Q� Signature Title (plse print)at-MIiW (over) DOH-1555 (02/2004)