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Klemish, Randi Lr z I NEW YORK STATE DEPARTMENT OF 1-I EALT41 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Randi B. Klemish Female Date of Death Age If Veteran of U.S. Armed Forces, Y= May 27,2017 67 War or Dates i„,' Place of Death Hospital, Institution or Z: City, Town or Village Lake George Street Address 72 McGillis Avenue © Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending 1,13 Circumstances Investigation tu Medical Certifier Name Title 0 Sarah Walton PA Address HHHN,Warrensburg,NY 12885 Death Certificate Filed District Number Register Number City, Town or Village Lake George 5620 ❑Burial Date Cemetery or Crematory El Entombment May 31,2017 Pine View Crematory Address ®Cremation 21 Quaker Rd., Queensbury, NY 12804 Date Place Removed Z Removal and/or Held and/or Address H Hold CO O Date Point of NTransportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address ° Permit Issued to Registration Number Name of Funeral Home Alexander-Baker Funeral Home 00037 Address `."' 3809 Main Street,Warrensburg,NY 12885 Name of Funeral Firm Making Disposition or to Whom Kati Remains are Shipped, If Other than Above A• ddress 10 fit. P• ermission is hereby granted to dispose of the human remains described boy s indica ed. Date Issued /5/31 ,20/7 Registrar of Vital Statistics ,70Q)1/4.22_,24.4... (signature) District Number Place Y 1 I l Q e, of La ke_ Can e I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: wp Date of Disposition 4'/ Z I n Place of Disposition ?hiT-0. C,. .clit6r,L— W (address) U) rZ (section) l/, (lot number) (grave number) p Name of Sexton or Person in Charge of Premises /ht ltir SP 10I4,µ Z (ple se print) w Signature Z1 Title tr>✓ V(. (over) DOH-1555 (02/2004)