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Caples, Joan A- 051 NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Joan Caples Female Date of Death Age If Veteran of U.S.Armed Forces, '; 12/27/2020 89 Years War or Dates Place of Death �*' Hospital,Institution or ZCity,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc p Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined El Pending U Circumstances Investigation LU 0 Medical Certifier Name Title Diane Westbrook NP Address 131 Lawrence St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 686 ElBurial Date Cemetery,Crematory or Facility Name 12/28/2020 Pine View Crematory 11 Entombment Address ElCremation Queensbury Town,New York EDonation z Date Place Removed O 0 Removal — and/or and/or Held I . - Hold Address 0 Li) ❑Transportation Date Point of p by Common Shipment Carrier Destination Disinterment Date Cemetery Address 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 )-. Remains are Shipped,If Other than Above Address CC a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/28/2020 Registrar of Vital Statistics John PPaul'Franck(ECectronicaCCy Signed) (signature) District Number 4501 Place Saratoga Springs, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— W Date of Disposition t'Z-Z9 Zp Alit of Disposition � ei 2 /(address) W 11Y (section) (lot number) (grave number) aName of Sexton or Person in arge of Premises �Wlr4N / Q Z (please print) / W Signatures Title �Ync / ?� �,t 6/A/�� DOH-1555(07/18)p 1 of , 0I434 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#