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Quintana, Karen NEW YORK STATE DEPARTMENT OF HEALTH rJIL Vital Records Section Burial - Transit Permit Name First Middle Last Sex Karen Quintana Female Date of Death Age If Veteran of U.S. Armed Forces, February 7, 2017 65 War or Dates t Place of Death Hospital, Institution or WCity, Town or Village Moreau Street Address 115 Lamplighter Acres WManner of Death Natural Cause ❑ Accident D Homicide ❑ Suicide ❑ Undetermined ❑ Pending Circumstances Investigation W Medical Certifier Name Title 0 William A. Tedesco, M.D. Dr. Address 3 lrongate Center Glens Falls, NY 12801 Death Certificate Filed District Number Register Number City, Town or Village Moreau (p ❑Burial Date Cemetery or Crematory February 9, 2017 Pine View Crematory ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date 1 Place Removed Removal z ❑ f and/or Held 0 and/or Address P Hold N Date Point of d0 Transportation Shipment (I) by Common Destination a Carrier Date Cemetery Address ❑ Disinterment Date Cemetery Address El Reinterment 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 L Remains are Shipped, If Other than Above 2 Address w a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued (32/ 0/7 Registrar of Vital Statistics 4 ' 22. -C--_. (signature) District Number 1/ ? Place 7 Ji) of CA CtiLti. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: wDate of Disposition 02/09/2017 Place of Disposition Quaker Road Queensbury,NY 12804 Z (address) W IX (section) /z (l;:m ber) c (grave number) pName of Sexton or Person in Charge of Premises ° �ris Jt 1n t di (p ase print) W Signature L� 1A4. Title (O-6117/1 T (over) DOH-1555 (02/2004)