Loading...
Isidore, Edward Z.3 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Edward Isidore Male Date of Death Age If Veteran of U.S.Armed Forces, 01/31/2021 89 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Queensbury Town Street Address Glens Falls Center for Rehabilitation and Nursing WManner of Death © Natural Cause 0 Accident ❑Homicide ❑Suicide ElUndetermined El Pending Circumstances Investigation a• Medical Certifier Name Title Wendy Steinhacker PA Address 152 Sherman Ave,Queensbury Town,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 37 Burial Date Cemetery,Crematory or Facility Name 02/02/2021 Pine View Crematory Entombment Address 0 Cremation Queensbury Town,New York Donation • Removal Date Place Removed and/or and/or Held H Hold Address N 0 O. Date Point of t/! ❑Transportation 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 1— Remains are Shipped,If Other than Above a Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/01/2021 Registrar of Vital Statistics Caroline.7fi(fegarde Barber(Electronically Signed) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition ��3 Z+ Place of Disposition ,2 (address) W CC CC (section) 3(lot number) (grave number) G Name of Sexton or Person in Charge of emises (plea e print) W Signature ( Title (hacrN Ryt DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 1449 Receipt Human remains of delivered on , 20 • Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#