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Reese, BettyAnn { NEW YORK STATE DEPARTMENT OF HEALTH � Burial _ Transit Permit Vital Records Section Name First Middle Last Sex BettyAnn Reese Female Date of Death Age If Veteran of U.S. Armed Forces, 07/09/2017 92 Years War or Dates Place of Death Hospital, Institution or - City, Town or Village Granville Village Street Address Indian River Rehabilitation And Nursing Center Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined Fl❑Pending Circumstances Investigation Medical Certifier Name Title Thomas Kandora MD Address • 17 Madison St,Granville Village,New York 12832 Death Certificate Filed District Number Register Number City, Town or Village Granville Village 5725 16 W,CI Burial Date Cemetery or Crematory 07/11/2017 Pine View Crematory ['Entombment Address ®Cremation Queensbury Town, New York Date Place Removed Removal and/or Held and/or Address Hold Date Point of ❑Transportation Shipment by Common Destination Carrier El Disinterment Date Cemetery Address Date Cemetery Address El Reinterment Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 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 07/11/2017 Registrar of Vital Statistics cc1ichard`R'6erts E[ectronica[[ySigned (signature) District Number 5725 Place Granville Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition )1 13f n Place of Disposition fm6Uv le— (address) (section) (10 number) (grave number) Name of Sexton or Person in Charge of P emises it e Simfit (p/easeprint) - Signature Title falestria (over) DOH-1555 (02/2004)