Hamilton, Jeanne NEW YORK STATE DEPARTMENT OF HEALTH * it 7M J
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Jeanne Hamilton Female
• Date of Death Age If Veteran of U.S. Armed Forces,
May 6, 2012 80 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Street Address 20 Homer Avenue
Manner of Death rwqNatural Cause 0 Accident n Homicide 0 Suicide n Undetermined El Pending
Circumstances Investigation
Medical Certifier Name Title
Thomas Portuese,
a• - Address
100 Broad St. Glens Falls, NY 12801
A, J�rbyr
Death Certificate Filed D ct ' Register Number
City, Town or Villagei l o 1
0 Burial Date Cemetery or Crematory
May 9, 2012 Pine View Crematory
0 Entombment Address
®Cremation
Date Place Removed
0 Removal and/or Held
and/or Address
Hold
Date Point of
, ❑Transportation Shipment
by Common Destination
Carrier
a• ` Disinterment Date Cemetery Address
0 Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home 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 here y granted to dispose of the human rennai s describe bo a iindicated.
Date Issued)g �(40(� Registrar of Vital Statistics ��f -1, �� J 2(-----
_ ( CD
(signature)
District Numbe (q c`� Place ( Q �.--,--• d 4 Sh
I certify that the remains of the decedent identified above were disposed of in accordance ' h t s permit on:
Date of Disposition 05/09/2012 Place of Disposition ga 6
(address)
(section) ,(lot number) S (grave number)
F Name of Sexton or Person in Ch ge of Premises 1` 41
Tease print)
Signature 474Title CerviMpeOK,
(over)
DOH-1555(02/2004)