Kuhn, Katherine " / / /
NEW YORK STATE DEPARTMENT OF HEALTH -- x..,t Burial - Transit Permit
Vital Records Section
iNi Name First Middle Last Sex
Katherine Therese Kuhn F
Date of Death Age If Veteran of U.S. Armed Forces,
03/11 /2014 64 War or Dates
154 Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
ii Manner of Death �Undetermined Pending
' Natural Cause x Accident Homicide Suicide
it/ Circumstances Investigation
tu Medical Certifier Name Title
a Paul 13achman MD
Address
9 Carey Road, Queensbury,NY 12804
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5 60 1 1 1 G
il!I❑Burial Date Cemetery or Crematory
03/14/2014 Pineview Crematory
❑Entombment Address
DCremation Quaker Road, Queensbury, NY 12804
Date Place Removed
❑Removal and/or Held
..� and/or Address
i=` Hold
Date Point of
EL Transportation Shipment
a by Common Destination
Carrier
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home MB Kilmer Funeral Home 01 078
Address
136 Main St. , South Glens Falls, NY 12803
gli Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
a Address
LC
fa
CL
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 3 t/3/ t LI Registrar of Vital Statistics Wc.A.A ..i- W
(signatur
<i District Number 56o 1 Place 6, ,,c, V� \ S ( ( y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tit Date of Disposition 1—iI`J�—f 4/ Place of Disposition iI1',i ��2� 0114,47/74414/
(address)
LEI
44.
(section) (lot number) (grave number)
Name of Sext or P r 7n in Charge of Premises Sc.a D tiJ
(please pant)
tti
Signatur (-- Title C�'Ify1/9 Ind. /k J
(over)
DOH-1555 (02/2004)