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Atwood, Paula E.
id a #11 1 r . f s NEW YORK STATE DEPARTMENT OF H EALTH ' `-. 1 1 Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Paula E.Atwood Female Date of Death Age If Veteran of U.S.Armed Forces, 10/19/2020 90 Years War or Dates E. Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc pManner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide Undetermined ❑Pending W 0Circumstances Investigation l Medical Certifier Name Title John Quaresima MD Address 319 Broadway,Fort Edward Town,New York 12828 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 88 ❑Burial Date Cemetery,Crematory or Facility Name 10/20/2020 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury,New York ❑Donation Z �Removal Date Place Removed ▪ and/or and/or Held F- Hold Address to 0 a Date Point of Cl) ❑Transportation Shipment 15 by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward, New York 12828 Name of Funeral Firm Making Disposition or to Whom t_ Remains are Shipped,If Other than Above a▪ Address cr W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/20/2020 Registrar of Vital Statistics Aimee Mahoney(ECectronicafly Signed) (signature) District Number 5755 Place Fort Edward, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition /D1M to Place of Disposition F..41,...... 4,ri g (address) W Ncc (section) A /lot number) (grave number) aName of Sexton or Person in Charge f Premises ti 1,... S D%A U Z (pt se print) W Signature Title ` o"ti rse DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 10 1111 3 1 Receipt Human remains of delivered on ' , 20 • Pine View Cemitery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# •