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Kende, Beverly t NEW YORK STATE DEPARTMENT OF HEALTH t-- , Burial - Trans" -1106rrnit Vital Records Section Name First Middle Last Sex Beverly L . K. Kende Female Date of Deathe, If Veteran of U.S.Armed Forces, 06/22/2013 88 War or Dates No F— Place of Death Hospital, Institution Z City ,Town or Village City of Albany or Street Address St. Peter's Health Partners W Manner of Death Natural Undetermined Pending ® Cause ❑ Accident ❑ Homicide ❑ Suicide El Circumstances Investigation W` Medical Certifier Name Title © Joyce Yang MD Address 315 S. Manning Blvd. Albany, NY 12208 Death Certificate Filed District Number Register Number City,Town or Village City of Albany 101 1216 Date Cemetery or Crematory ❑ Burial 06/24/2013 Pine View Crematory 0 Entombment Address Z Cremation Queensbury, NY Date 1 Place,Removed Z Removal and/or Held Q ❑ and/or Address H Hold a Q Date Point of 1 Transportation Shipment U) ❑ By Commonfli Carrier Destination El Disinterment Date Cemetery Address Date Cemetery Address ❑ Reinterment Permit Issued To Registration Number Name of Funeral Home M.B. Kilmer Funeral Home 01078 Address 136 Main Street So. Glens Falls, NY 12803 Name of Funeral Firm Making Disposition or to Whom F,:- Remains are Shipped, If Other than Above a' Address CZ ILI ©.i Permission is hereby granted to dispose of the human remains described above as indicated. Date 06/24/2013 Registrar of Vital Statistics e-1l2�L4 ( • I `` Issued (signature) SW District Number 101 Place City of Albany, NY I certify that the remains of the decedent identified above were disposed of in((a��ccordancewith this permit on: Z` Date of Disposition (a'Z C-13 Place of Disposition 1'ta,...✓ C/ 4frv. W (address) 2 W E/) 0 (section) of number) (grave number) - Name of Sexton or Person in Charge of Premises tLjj p( 4.0 Ili please print) 1 Signature 41Title Clethfirig (over) DOH-1555(02/2004)