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Kill, Regina s . -4 / NEW YORK STATE DEPARTMENT OF �LTH /� 'Vital Records Section Burial - Transit Permit uc, Name First Middle Last Sex Regina Marie Kill Female Date of Death Age eteran of U.S. Armed Forces, 09/18/2017 86 Years - War or Dates == Place of Death Hospital, Institution or WCity, Town tdr Village Granville Village Street Address Indian River Rehabilitation And Nursing Center Q Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending F Circumstances Investigation W Medical Certifier Name Title 0 Scott Biasetti MD Address 1 100 Park St,Glens Falls,New York 12801 tt Death Certificate Filed District Number Register Number City, Town or Village Granville Village 5725 26 `'❑Burial Date Cemetery or Crematory 09/20/2017 Pine View Crematorium ❑Entombment Address ®Cremation Queensbury Town, New York Date Place Removed Z❑Removal and/or Held Q and/orPii Address Cl Hold 0 Date Point of • ❑Transportation Shipment Q by Common Destination Carrier .. ❑Disinterment Date Cemetery Address e❑Reinterment Date Cemetery Address Permit Issued to Registration Number • Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Stpo Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom f Remains are Shipped, If Other than Above Address O W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/20/2017 Registrar of Vital Statistics tcfiard Rnferts 'ECectronicalySigned (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: Z ILI Date of Disposition (fiat 7 Place of Disposition ge t,.) (�►.44-0,N— Z (address) LI Cl) Ct (section) /lot number) (grave number) ci Name of Sexton or Person in Charge o Premises ` Af,a -JI'iie if z (pleeibe print) w Signature Li �- Title (tEmltri�c, (over) DOH-1555 (02/2004) — i:7/-- 57<. Gd.MPr_dr-- A\ Rc \ Lôo Address dig Phone # Lot # Deed # Date Cost Foundation Y - N Location G-?' U) Gv Remarks % VaR C,\r \Oct-- e. . P Near born Record of Interments 1 6 2 7 3 8 4 9 5 10 (-0\ \)31 `IY .4( . mptp 't- ,ipinex\ S\:e 11 i,e_. > 5iS I'ie Il i e @ rlIoo •c,om Xvarr‘e. I e > i 9ske ll i e. C `i G h0° '`CI"M 2L,VndA t `ne,Q 7 C l - u-D3 rneA.Q, au4Laok•can" ;Grle S1I,C Ili< > 51).,cll►camc ofma,L •`' " V) kb ar›►i II!A mi11:Q . ' 3 gyS I J- �+ `� U1 .., '' �� -7 177--,*S . -7 7 ,S I (i o _ - 4' .,.q.) ci ai t 7 /H..Q�o4 `i • ,'J.r s4/77 ,y3 rr• 7 7,� 4/ i h c61 .) fSy brNi;_: Z %) j�fj���r/J� i r� I 1 - ` 1, ec '77-V 1j 'i JaLa fioA/ ? . Ly' a, J! r t4,- Lti t ......--) iv-x.74,50H ,,, • N _PAV 5. cl Ni I #5oN 1"1 u2' i A ' A�4O I 1 XPe/A M s� J -n�S Q (v* 77 , t / s w�� sb�cly�r�ti 1110.441-21--- 2txt Q v - / 99L KILL NAME Regina KIll Age: 86 Lot Owner: Kill Plot Lot# Grave# Case: Urn Died: 9/1 8/2 017 Interred:9/2 8/2 01 7 Funeral Home: Carletons Cemetery: WEst Glens Falls Cemetery