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Kitt, Loren NEW YORK STATE DEPARTMENT OF HEALTI-. Vital Records Section Burial - Transit Permit Name First Middle Last Sex & - Loren Wayne Kitt Male Date of Death Age If Veteran of U.S.Armed Forces, 09/04/2017 76 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Ci Manner of Death©Natural Cause El Accident 0 Homicide 0 Suicide ElUndetermined ri Pending I ! Circumstances Investigation : Medical Certifier Name Title Jean Vanauken PA Address ka 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number EA'''' City, Town or Village Glens Falls 5601 473 ❑Burial Date Cemetery or Crematory 09/07/2017 Pine View Crematory 1,❑Entombment Address ®Cremation Queensbury Town, New York Date Place Removed ❑Removal and/or Held and/or Address h Hold 1 1U, Date Point of ❑Transportation Shipment ct by Common Destination Carrier ❑Disinterment Date Cemetery Address Reinterment Date Cemetery Address ▪.s Permit Issued to Registration Number . Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 a Address {4r 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom PRemains are Shipped, If Other than Above Address 1 i Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/06/2017 Registrar of Vital Statistics Rg6ertJ4 Curti EfrctmnicalrySigned" (signature) KO at District Number 5601 Place Glens Falls, New York 14 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 7 y/7 Place of Disposition ,%jheki, Z-/-2-e ,f� (address) ti ft (section) ` (lot nu ber) (grave number) et J Name of Sexton or P r n ' harge of Premises t#V11 ✓t 6,IT £-U)`'e (please print) Signature Title G,wna-/i/- (over) DOH-1555 (02/2004)