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Krakat, Elizabeth 90 NEW YORK STATE DEPARTMENT OF HEALT-11p,4111. Vital Records Section Burial - Transit Permit kli Name First Last Sex Elizabeth Anne Krakat Female Date of Death Age If Veteran of U.S.Armed Forces, 01/23/2018 53 Years War or Dates Place of Death Hospital, Institution or 0 City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause 0 Accident 0 Homicide 0 Suicide EiUndetermined n Pending Circumstances Investigation 01 ini Medical Certifier Name Title Michael Miles MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 43 ❑Burial Date 1 Cemetery or Crematory 01/25/2018 Pine View Crematory ❑Entombment Address ®Cremation Queensbury Town, New York Date Place Removed Removal and/or Held and/or Address Hold i. Date Point of ° Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address 0 Reinterment Date Cemetery Address . 4 Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom III Remains are Shipped, If Other than Above Address 1-0 $f Permission is hereby granted to dispose of the human remains described above as indicated. 041 f Date Issued 01/24/2018 Registrar of Vital Statistics RpbertACurtiu(ECectronica1TySigned) (signature) tfri tit District Number 5601 Place Glens Falls, New York 'q I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: rl vii Date of Disposition f/24lit Place of Disposition 4' \j� /., 10,... Lril (address) f (section) (lot number) (grave number) Name of Sexton or Person in Charge of P miser tn;1 —' �a-111- (p ase print) lil Signature Title fq ( (over) DOH-1555 (02/2004)