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Gimmler, David NEW YORK STATE DEPARTMENT OF HEALTH ' 4 3 1 Vital Records Section Burial - Transit Permit --, Name First Middle Last Sex David A Gimmler Male Date of Death Age If Veteran of U.S.Armed Forces, I. April 25, 2018 83 War or Dates 1957-1959 2 Place of Death Hospital, Institution or W City,Town,or Village Dresden Street Address Home 0 Manner of Death 'Natural Cause El Accident 11 Homicide 0 Suicide Ej Undetermined 0 Pending W Circumstances Investigation 0 Medical Certifier Name Title Ili Glen Chapman MD Q Address 102 Race Track Rd Suite 1, Ticonderoga NY 12883 Death Certificate Filed District Number Register Number City,Town or Village Whitehall 5752_ ©? El Burial Date Cemetery or Crematory April 30, 2018 Pineview Crematorium ❑Entombment Address q El Cremation 21 Quaker Road Queensbury, NY 12804 Date Place Removed 0 0 Removal and/or Held • and/or Address r Hold 0 Date Point of 0 Ej Transportation Shipment A by Common Destination i Carrier Date Cemetery Address El Ell Disinterment 0 Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Jillson Funeral Home, Inc. 00885 Address 46 Williams Street, Whitehall, New York 12887 Name of Funeral Firm Making Disposition or to Whom 2,• Remains are Shipped, If Other than Above W Address 0. Permission is hereby granted to dispose of the human remains described above asJ indicated. Date Issued 4/2-6 f I Registrar of Vital Statistics ',4&4A� J4,L1L (A) 7.N - (signature) "� District Number5c,' 75 Place ',New York T t�h ot vr�'6G�Gv1 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F- 2 � Date of Disposition 04/30/2018 Place of Disposition Pineview Crematorium (address) W to t (section) /ii(lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises l lilt, . S` �t W ( e print) Signature 14 a IV Title lzEotila0- (over) DOH-1555 (02/2004)