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Ketcham, Kathryn Aurelia NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kathryn Aurelia Ketcham Female Date of Death Age If Veteran of U.S.Armed Forces, 01/18/2021 65 Years War or Dates 1975-1976 �.. Place of Death Hospital,Institution or WCity,Town or Village Kingsbury Town Street Address 308 Queens Dr.A,Kingsbury Town, New York 12839 p Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title Aimee Mcmaster Nurse Practitioner,Acute Care Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Kingsbury Town 5762 4 ❑Burial Date Cemetery,Crematory or Facility Name 01/20/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation 0 ❑Removal Date Place Removed and/or and/or Held - Hold Address 0 d Date Point of N ❑Transportation Q by Common Shipment Carrier Destination Date Cemetery Address ❑Disinterment ❑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 F- Remains are Shipped,If Other than Above 2 Address rC W u' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/19/2021 Registrar of Vital Statistics Cynthia ABar1in(ECectronica(rySigned) (signature) District Number 5762 Place Kingsbury Town, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 11 21 1 ZI Place of Disposition 2 (address) W CC N (section) t number) (grave number) it O Name of Sexton or Person in Charge of Premi r• `� Z (please' int) �^ W Signature Title 6'3 44' DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 014435 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#