Munoff, Barbara PV
NEW YORK STATE DEPARTMENT OF HEALTH ? '7 1C 1/17
Vital Records Section Burial - Transit Permit
Name First Barbara Midclnn Last Munoff Sex
Date of Death 0 5/2 8/2 01 7 Age 78 __._If_Veteran of U.S. Armed Forces,
War or Dates
Place of Death Hospital, Institution or
Glens Falls Glens Falls Hospital
City, Town or Village Street Address
14,1
Manner of Death Natural Cause 0 Accident ❑Homicide ❑Suicide ❑Undetermined El Pending
Circumstances Investigation
W Medical Certifier Name Title
a
Address
Death Certificate Filed Glens Falls District Number Regist,Nuum
City, Town or Village 57,a 0 / //
❑Burial Date 05/30/2017 Cemetery or Crematory Pine View Crematory
❑Entombment Address
®Cremation 21 Quaker Rd Queensbury, NY 12804
Date Place Removed
Z ❑Removal and/or Held
4 and/or Address
1•1- Hold
8 Date Point of
i 0 Transportation Shipment
el by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to M.B. Kilmer Funeral Home Registration Number
Name of Funeral Home 01 078
Address 136 Main St South Glens Falls, NY 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
„ Address
cc
ILA
£" Permission is h reb granted to dispose of the human I.:mains described a• ve as indic• ed.
Date Issued 05 :�) �) Registrar of Vital Stat tics Adx: ! .' Air '
i (signature)
hi District Number 5( I Place �%�=� `,2
J
I certify that the remains of the decedent identified above were disposed of in accordance ith this permit on:
k
w Date of Disposition 3/'37/7 Place of Disposition Pan t v,�,,J ,,) 6 it,4144,1ry
Ul / (address)
Cl)
CC (section) (lot nurrjber) (grave number)
0 Name of Sexton a soon in Charge of Premises 1rG.✓► a.m 1,-c.1►-e
(please print)
LE Signature i Title L��'`��
(over)
DOH-1555 (02/2004)