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Anderson, Lulumae NEW YORK STATE DEPARTMENT OF HEALTH r ; t # ill Vital Records Section Burial - Transit Permit — Name First Middle Last Sex Lulumae Laura Anderson Female Date of Death Age If Veteran of U.S. Armed Forces, August 27, 2018 77 War or Dates Place of Death Hospital, Institution or City, Town or Village Kingsbury Street Address 1898 County Route 43 Manner elf Death 0 Natural Cause Accident ❑ Homicide 0 Suicide Undetermined El❑ Investigation Pending Medical Certifier Name Title Circumstances Scott Munro, Address 6 Hearts Way Queensbury, NY,12804 „..-, ' Death Certificate Filed District Number Register y.,umber City, Town or Village Kingsbury Jt L CCU 0 Burial Date Cemetery or Crematory . August 30, 2018 • Pine View Crematory 0 Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed ❑ Removal and/or Held and/or Address Hold 0` Date Point of illiTransportation Shipment by Common Destination 0 Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M.B. Kilmer Funeral Home-SGF 01078 Address 136 Main Street, South Glens Falls NY 12803 Name of Funeral Firm Making Disposition or to Whom I- Remains are Shipped, If Other than Above Address ;. Permission is hereby granted to dispose of the human remains scribed above as indicated. Date Issued S -a Y'- 10 /8 Registrar of Vital Statistics "�` ':-'�. cz,_—._ -, (signature) District Number .;j'& P Place '''.---�o-� —/ )- ' '1`36- - / I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 08/30/2018 Place of Disposition Quaker Road Queensbury,NY 12804 (address) a (section) (lot number) (grave number) Name of Sexton or Person in Charge of Pre ises it cL .,� � (please print) {. Signature �r Title f'>rtels'irl 't. (over) DOH-1555 (02/2004)