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Guilder, Caroline it (f or NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit if Name First Middle Last Sex Caroline E.Guilder Female • Date of Death Age If Veteran of U.S. Armed Forces, _ 05/20/2018 91 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation • Manner of Death© Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined El❑Pending Circumstances Investigation Medical Certifier Name Title Gwendolyn Morris-Dickinson PA Address 170 Warren St,Glens Falls,New York 12801 Ets Death Certificate Filed District Number Register Number City, Town or Village Glens Falls 5601 247 '3 ❑Burial Date Cemetery or Crematory 05/21/2018 Pine View Crematory ❑Entombment Address ®Cremation Queensbury Town, New York Date Place Removed `g T ri❑Removal and/or Held ia and/or Address Hold Date Point of cl ❑Transportation Shipment r by Common Destination Carrier ❑Disinterment Date Cemetery Address irk ❑Reinterment Date Cemetery Address N. Permit Issued to Registration Number k-:',271 Name of Funeral Home Brewer Funeral Home Inc 00211 TR Address 24 Church Street PO Box 500, Lake Luzerne, New York 12846 • Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above '-I Address Permission is hereby granted to dispose of the human remains described above as indicated. ta • Date Issued 05/21/2018 Registrar of Vital Statistics MenA Curtis(ECectronica1ty Signed) (signature) • District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordancec with this permit on: Date of Disposition clztlig Place of Disposition ��,d..1 C.A — .- (address) 3 (section) 1 (lot numb) (grave number) Name of Sexton or Persod in Charge f Premises Alva s.at4 - ea( se print) `- Signature a Title Ott (over) DOH-1555 (02/2004)