Palmieri, Crystal #
NEW YORK STATE DEPARTMENT OF HEALTH
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Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Crystal Ellen Palmieri F
Date of Death Age If Veteran of U.S. Armed Forces,
04/30/2014 65 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address The Pines
Manner of DeathUndetermined Pending
x❑Natural Cause Accident❑ ❑Homicide ❑Suicide ❑ ❑
lu Circumstances Investigation
ta Medical Certifier Name Title
O Bernardo Villajuan Mn
Address
161 Carey Road, Queensbury,NY 12804
Death Certificate Filed District Number `` Register Number
City, Town or Village I \ `J
❑Burial Date Cemetery or Crematory
05/01 /201 4 Pineview Crematory
['Entombment Address
[Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z❑Removal and/or Held
2 and/or Address
F- Hold
Cl)
0 Date Point of
050 Transportation Shipment
G by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
TlE! Permit Issued to Registration Number
Name of Funeral Home MB Kilmer Funeral Home 01 078
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 hereby granted to dispose of the human remains described above as indicated.
Date Issued 5 / I I '`/ Registrar of Vital Statistics
(signature
District Number 5-(70 j Place 6 (Stik/ S S 1 k S )
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ttf• Date of Disposition S J soil Place of Disposition
(address)
0
(section) (lot numb (grave number)
0
p Name of Sexton or Person in Charge of Premises r}st+,p(— pda*
r (please p t)
Signature Title rierpa
(over)
DOH-1555 (02/2004)