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Griffin, Beverly Bea it NO NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Beverly Bea Griffin Female Date of Death Age If Veteran of U.S.Armed Forces, 10/19/2020 75 Years War or Dates i., Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death © Natural Cause Ei Accident Ei Homicide n Suicide ❑Undetermined Pending W Circumstances Investigation U IW Medical Certifier Name Title O Michael Miles MD Address 152 Sherman Ave,Queensbury Town,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 479 O Burial Date Cemetery,Crematory or Facility Name 10/20/2020 Pine View Crematory 0 Entombment Address 0 Cremation Queensbury Town,New York ▪Donation ©CI Removal Date Place Removed and/or and/or Held - Hold Address O tL Date Point of Cl) ❑Transportation Shipment d 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-South Glens Falls 01078 Address 136 Main St,S Glens Falls, New York 12803 Name of Funeral Firm Making Disposition or to Whom • Remains are Shipped,If Other than Above 2 Address W • Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/20/2020 Registrar of Vital Statistics ggbert(Andrew Curtis(EtectronicaCTy Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 2 Zi•-• Date of Disposition )U/Zt1 ZO Ptace of Disposition g (address) W (section) (1st number) (grave number) O Name of Sexton or Person in Charge o Premises r,Juov►.,�b ease prin W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 1111 3 0 Receipt Human remains of k' v delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#