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Wiltshire, Gary . .j # 7,7 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Gary Wiltshire Male Date of Death Age If Veteran of U.S.Armed Forces, 01/06/2021 63 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare p Manner of Death ©Natural Cause El Accident 0 Homicide ❑Suicide 0Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title O Leonard Gelman MD Address 4573 State Route 40,Argyle Town,New York 12809 Death Certificate Filed District Number Register Number City,Town or Village Argyle 5750 2 ElBurial Date Cemetery,Crematory or Facility Name 01/08/2021 Pine View Crematory Entombment Address 0 Cremation Queensbury Town,New York Donation Z Removal Date Place Removed and/or and/or Held F- N Hold Address 0 d Date Point of V) L j Transportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077 Address 123 Main St,Argyle,New York 12809 Name of Funeral Firm Making Disposition or to Whom f- Remains are Shipped,If Other than Above 2 Address r W 0. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/06/2021 Registrar of Vital Statistics SielTey Mc(grnon(E(ectronically Signed) (signature) District Number 5750 Place Argyle, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:Zt— L I— WDate of Disposition I/$i tI Place of Disposition 2 (address) W CC (section) ��!ot number/ (grave number) Name of Sexton or Person in Charge of'Pre ' es r' l' � ' (pleast'print) WZ Ci'IaGN►j�1L Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) ' I 43 R Receipt Human remains of -- delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#