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Skellie, Willard NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permi Vital Records Section Name First Middle Last Sex Male Willard Francis Skellie Date of Death Age If Veteran of U.S.Armed Forces, 07/17/2017 74 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 O Accident Homicide O Suicide O Undetermined Pending Circumstances Investigation Medical Certifier Name Title Shahid Ahmed MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 388 OBurial Date Cemetery or Crematory 07/18/2017 Pine View Crematory OEntombment Address ®Cremation Queensbury Town, New York Date Place Removed Removal and/or Held and/or Address Hold Date Point of O 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-Argyle 01077 Address 123 Main St,Argyle,New York 12809 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 07/17/2017 Registrar of Vital Statistics Men ACurtis ECectronicaITySigned" (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 ry/7 Place of Disposition ?Mt V j&) C/ 6.d0 (address) (section) ` (loumber) (grave number) ott� Name of Sexton erso in Charge of Premises V(4.,/ �� .74-4414 (please print) Signature Title �/ ''1e...'47./ (over) DOH-1555 (02/2004)