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Reed, Carol NEW YORK STATE DEPARTMENT OF HEALTH , 4 slog Vital Records Section Burial - Transit Permit Name First Middle Last Sex Carol Lee Reed Female Date of Death Age If Veteran of U.S. Armed Forces, December 17, 2016 59 War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls , Street Address Glens Falls Hospital Manner of Death Natural Cause 1=1 Accident Homicide ❑ Suicide ❑ Undetermined ❑ Pending Circumstances Investigation Medical Certifier Name Title William Cleaver, M.D Address 100 Park Street Glens Falls, NY 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls , ❑Burial Date Cemetery or Crematory December 20, 2016 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 Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address VII - 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 hereby granted to dispose of the human remains described above as indicated. Date Issued {2/ 2411 Registrar of Vital Statistics cY•Q- W (signett)fe) District Number S bO I Place 6 C N s \. 5, AI V ffi I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 12/20/2016 Place of Disposition Quaker Road Queensbury,NY 12804 (address) (section) (lot number) (grave number) 1// Name of Sexton or Person in Charge of Premises ((i, Sts+llit (ple se print) Signature Gil Title AFAIfi (over) DOH-1555 (02/2004)