Gagliardi, Linda / V,J
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
67 Name First Middle Last Sex
Linda Susan Gagliardi Female
Date of Death Age i If Veteran of U.S. Armed Forces,
02/22/2018 54 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined IT❑Pending
Circumstances Investigation
Medical Certifier Name Title
d Leonid Bilenkin MD
Address
100 Park St,Glens Falls,New York 12801
• Death Certificate Filed District Number Register Number
A City, Town or Village Glens Falls 5601 100
❑Burial Date Cemetery or Crematory
02/28/2018 Pine View Crematory
❑Entombment Address
'®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
F and/or Address
Hold
Date Point of
Si❑Transportation Shipment
• by Common Destination
r Carrier
❑Disinterment Date Cemetery Address
0 Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078
Address
136 Main St,S Glens Falls,New York 12803
• Name of Funeral Firm Making Disposition or to Whom
il—F Remains are Shipped, If Other than Above
Address
Its
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/26/2018 Registrar of Vital Statistics Robert A Curtis(ElectronicafySigned)
(signature)
• District Number 5601 Place Glens Falls, New York
F- I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
1 Date of Disposition 311 I t Place of Disposition &iU... 4..5,i.._..
(address)
(section) (lot number)C (grave number)
Name of Sexton or Person in Charge of Premises (� se print) `"'4.
Signature �'� (pl a
Title ii?Ptifi PY7
(over)
DOH-1555 (02/2004)