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Prentice, John Travers NEW YORKSTATE DEPARTMENT OF HEALTH r Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John Travers Prentice Male Date of Death Age If Veteran of U.S.ArmedForces, 01/09/2021 90 Years War or Dates WWII 1... Place of Death Hospital,Institution or Z-City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare O Manner of Death © Natural Cause 0 Accident 0 Homicide 0 Suicide El Undetermined 0 Pending U 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 3 EIBurial Date Cemetery,Crematory or Facility Name 01/15/2021 Pine View Crematory 0 Entombment Address jCremation Queensbury Town,New York ❑Donation Z 0 Removal Date Place Removed and/or and/or Held H Hold Address N 0 Date Point of N Transportation Shipment 0 by Common Carrier Destination Ei Disinterment Date Cemetery Address Date Cemetery Address 0 Reinterment 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 E.- Remains are Shipped,If Other than Above 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/11/2021 Registrar of Vital Statistics Shelley Mckernon(Electronically 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:e W Date of Disposition /Z I 1 7( Place of Disposition i►.V� (address) g W COit (section) n(lot number) (grave number) O r.v O Name of Sexton or Person in Charge of Premi s (plea print/ z W Signature a Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 14 4 3 8 Receipt Human remains of s i delivered on , 20, Pine View Cemetery Repfesenting the funeral-hoir named on burial permit Official Funeral Directors Reg.or License# `' e • f