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Austin, Kenneth '. I `i2Z NEW YORK STATE DEPARTMENT OF HEAUTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex `S Kenneth J.Austin Male at Date of Death Age If Veteran of U.S.Armed Forces, ro 05/25/2018 73 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 El Accident El Homicide 0 Suicide 0 Undetermined El Pending Circumstances Investigation Medical Certifier Name Title Asim Chaudry MD Address E 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 265 ❑Burial Date Cemetery or Crematory 05/30/2018 Pine View Crematory El Entombment Address s ®Cremation Queensbury Town, New York Date Place Removed k ❑Removal and/or Held and/or Address Hold Date Point of Q Transportation Shipment by Common Destination -74, Carrier Q Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number s 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 `A}_ Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. WI Date Issued 05/29/2018 Registrar of Vital Statistics Men A Curtis(ECectronicaCCySigned) (signature) District Number 5601 Place Glens Falls, New York g. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition C130I4 Place of Disposition gt,.41.,1 jam}}` (address) lr (section) Ipt number) (grave number) Name of Sexton or Person in Charge of Premises h� '� (pleae print) (i*iv Signature Title 1 �� g (over) DOH-1555 (02/2004)