Hunt, Jo-Anne it
NEW YORK STATE DEPARTMENT OF HEALTH . t `
Vital Records Section Burial - Trans t Permit
A
Name First Middle Last Sex
Jo-Anne Hunt Female
Date of Death Age If Veteran of U.S. Armed Forces,
September 25, 2016 72 War or Dates
xPlace of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
Medical Certifier Name Title
Noelle Stevens, M.D. Dr.
Address
100 Broad Street Glens Falls, NY 12801
Death Certificate Filed District Number Registe
City, Town or Village Glens Falls ' a1 %
❑Burial Date Cemetery or Crematory
September 27, 2016 Pine View Crematory
El Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
and/or Address
Hold
Date Point of
0 Transportation Shipment
• by Common Destination
Carrier
Date Cemetery Address
❑ Disinterment
Date Cemetery Address
❑ Reinterment
Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home-SGF 01078
Address
136 Main Street, South Glens Falls NY 12803
Name of Funeral Firm Making Disposition or to Whom
• Remains are Shipped, If Other than Above
": Address
` Permission is he eby ranted to dispose of the huma remains . -scribed •bove as in. cated
Date Issued Registrar of Vital Statistics /,1% ( �s / _S AL'
r I i gnat of
Distri
ct Numbe �6 Place ' , a
I certify that the remains of the decedent identified above were disposed of in accordance with t is permit on:
Date of Disposition 09/27/2016 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
W
S (section) r (lot number) (grave number)
2 Name of Sexton or Person in Charge of Premises L'r,itP�^ S,a�atl9
' (please print)
Signature LI Title CIZCIAPPL
(over)
DOH-1555 (02/2004)