Hotaling, Kimberly 4- 31
NEW YORK STATE DEPARfMENTbF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Kimberly J. Hotaling Female
Date of Death Age If Veteran of U.S. Armed Forces,
December 25,2016 43 War or Dates
1,;: Place of Death Hospital, Institution or
_:Z: City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death 0 Natural Cause I I Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
a John Stoutenberg
Address
, 102 Park Street,Glens Falls,NY 12801
Death Certificate Filed District Number Register Nubr
City, Town or Village Glens Falls 5601 p.3
❑Burial Date Cemetery or Crematory
December 27,2016 Pine View Crematory
ill Entombment Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
O Date Point of
N Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
" Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
L Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued _)Z12.'71 /6 Registrar of Vital Statistics ti)C;A, y'
(signet )
District Number 5-Go i Place 6 csiA,. .5 l\s jdJ 9
I certify that the remains of the decedent identified above�were disposed of in accordance with this permit on:
W Date of Disposition) bJ /(�, Place of Disposition , ) ..)et)j 64,) 6cei,n4, l-i,
2 / (address)
W
CO
CL
(section) • _ (lot number) (grave number)
p Name of Sexton P •n Charge of Premises u Ca)/ (jc,,4IG L
Z (please print)
W Signature ! —. Title G/e-rna-h/-
(over)
DOH-1555 (02/2004)