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Heil, Mark NEW YORK STATE DEPARTMENT OF HEALTH - _. „ t1 371 Vital Records Section Burial - Transit Permit R. Name First Middle Last Sex Mark Edward Heil Male Date of Death Age If Veteran of U.S. Armed Forces, May 8, 2017 51 War or Dates Place of Death Hospital, Institution or City, Town or Village Fort Edward Street Address 4 Satterlee Lane E Manner of Death Natural Cause ❑ Accident E Homicide ❑ Suicide ❑ Undetermined ❑ Pending Circumstances Investigation „ Medical Certifier Name Title Robert Lemieux, Address 219 Pope Hill Road Argyle, NY 12809 Death Certificate Filed District Number /'7 RegisteriN tuber City, Town or Village Fort Edward /.4 ❑Burial Date Cemetery or Crematory May 10, 2017 Pine View Crematory ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed ❑ Removal and/or Held and/or Address Hold Date Point of 3.❑Transportation Shipment by Common Destination ' Carrier ElDisinterment Date Cemetery Address ❑ Reinterment Date Cemetery Address £i Permit Issued to Registration Number Name of Funeral Home M. B. Kilmer Funeral Home- FE 01079 Address 82 Broadway, Fort Edward NY 12828 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above address Permission is h reb granted to dispose of the hunins describ c\atort indicated. Date Issued 6 Registrar of Vital Statistics (signature) District Number51 55 Place J CLOA. V ± U rfACi I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ;, Date of Disposition 05/10/2017 Place of Disposition Quaker Road Queensbury,NY 12804 (address) e (section) (lot number) � (grave number) -01 Name of Sexton or Person in Charge of P emises 1*AA s�}o rk•` -S 1 i if (please rint) , Signature lif Title REti�IV( (over) DOH-1555 (02/2004)