Granger, Kenneth NEW YORK STATE DEPARTMENT OF HEALTH . .►
Vital Records Section Burial - Transit ermit
Name First Middle Last Sex
Kenneth Lee Granger Male
• Date of Death Age If Veteran of U.S. Armed Forces,
z May 24, 2014 85 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Kingsbury Street Address 118 Franklin Street
Manner of Death J Natural Cause ❑ Accident ❑ Homicide ❑ Suicide n Undetermined n Pending
tt, Circumstances Investigation
ik Medical Certifier Name Title
David Foote, Dr.
Address
340 Main St. Hudson Falls, NY 12839
ork
Death Certificate Filed District Number 1 Register Number
Ci , Town or Village Kingsbury 5 7 o_ I
-e ❑Burial Date Cemetery or Crematory
ik May 27, 2014 Pine View Crematory
iii❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal
and/or Held
and/or Address
Hold
.
Date Point of
❑Transportation Shipment
• by Common Destination
to Carrier
kii
ElDisinterment Date Cemetery Address
}
❑ Reinterment Date Cemetery Address
kik'�° Permit Issued to Registration Number
kit Name of Funeral Home M. B. Kilmer Funeral Home 01079
Y' Address
kk 82 Broadway, Fort Edward NY 12828
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.
;74Date Issued a —1 y Registrar of Vital Statistics
(signature)
0, District Number S 7 rn,L Place kip`S',(�u r�
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 05/27/2014 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) (lot number) � (grave number)
Name of Sexton or Person i Charge of Premises t t i, S„...tt
/
(pase print)
_ At � -- C W)I 2
Signature ii Title
(over)
DOH-1555 (02/2004)