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Kays, Glenn Marshall i32L9 NEWYORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Glenn Marshall Kays Male Date of Death Age If Veteran of U.S.Armed Forces, 12/29/2020 71 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death © Natural Cause 0 Accident ❑Homicide ❑Suicide ❑Undetermined 0 Pending W C.) Circumstances Investigation W Medical Certifier Name Title a Shahid Ahmed MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 604 ❑Burial Date Cemetery,Crematory or Facility Name 12/31/2020 Pine View Crematory Entombment Address 0 Cremation Queensbury Town,New York 0 Donation Z Removal Date Place Removed 0 and/or and/or Held H N Hold Address 0 Date Point of N Li Transportation Shipment p by Common Carrier Destination Date Cemetery Address ❑Disinterment Date Cemetery Address Reinterment 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 Remains are Shipped,If Other than Above a Address ltt W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/30/2020 Registrar of Vital Statistics Robert Andrew Curtis(Electronically Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition I2-3i-Z.c)?U Place of Disposition ?theu t �1 C re_,-,in (address) / W Et (section) ( umber) (grave number) 0 (/�,/!_ems C,9 G t✓L�-� Name of Sexton or Per n in Ch e of Premises (please print) W Title Cs a.0,1 a ix 0/0 Signature DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) .1 4 3 F ,P Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#—