Winter, Christopher . .
tiNEW YORK STATE DEPARTMENT OF HEALTH,
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Christopher Grant Winter Male
Date of Death Age If Veteran of U.S. Armed Forces,
07/09/2017 63 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death 0 Natural Cause ❑Accident Q Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
• Medical Certifier Name Title
Leonid Bilenkin MD
Address
100 Park St,Glens Falls,New York 12801
• Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 376
Buda l Date Cemetery or Crematory
07/11/2017 Pine View Crematory
El Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
77 by Common Destination
Carrier
El Disinterment Date Cemetery Address
Date Cemetery Address
❑Reinterment
• Permit Issued to Registration Number
4. Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079
Address
82 Broadway,Fort Edward,New York 12828
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 07/10/2017 Registrar of Vital Statistics Jvbea Curtis ECectronicaaySigned
(signature)
aN
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 l i f Z I f Place of Disposition 'f°Oc Carl etvriu
(address)
o (section) l(lot number) (grave number)
• Name of Sexton or Person in Charge of P emises (h4 P' S eM u t
(p/ se print)
ki
Signature Title �fil�ll�
(over)
DOH-1555(02/2004)