Soderman, JoAnne NEW YORK STATE DEPARTMENT OF HEALTH �_+ 8- 3i f
Vital Records Section . Burial - Transit Permit
-77
Name First Middle Last Sex
JoAnne Dolores Soderman Female
Date of Death Age If Veteran of U.S. Armed Forces,
April 28, 2015 83 War or Dates
Place of Death Hospital, Institution or
,;t City, Town or Village Fort Edward Street Address Fort Hudson Nursing Home
F Manner of Death IL.] Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
i Circumstances Investigation
Medical Certifier Name Title
Philip J. Gara, Dr.
Address
318 Broadway Fort Edward 12828
Death Certificate Filed District Number Regist t.lumber
City, Town or Village Fort Edward
❑Burial Date Cemetery or Crematory
April 28, 2015 Pine View Crematory
a-4❑Entombment
Address
. ®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
t.-g ❑ Removal and/or Held
and/or Address
Hold
Date Point of
' ❑Transportation Shipment
by Common Destination
Carrier
ElDisinterment Date Cemetery Address
F ❑ Reinterment Date Cemetery Address
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 reb granted to dispose of the hum n ins descr'be o s indicated.
Date Issued LI o_ 15 Registrar of Vital Statisti r
gnature)
District Number,�V)65 Place /O7J)X... 0-6ffasid a
>; I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
y Date of Disposition 04/28/2015 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) ��ff (lot number) (grave number)
Name of Sexton or Person in Charge o Premises �4<<. St-w-
4 ( lease print)
Signature Title aistilk,
(over)
DOH-1555 (02/2004)