Congdon, Janet Edna #I-0
NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Janet Edna Congdon Female
Date of Death Age If Veteran of U.S.Armed Forces,
02/10/2021 85 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 NI NaturalCause ❑Accident Homicide ❑Suicide ❑Undetermined Pending
U Circumstances Investigation
WGl Medical Certifier Name Title
Brandii Baker NP
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Argyle 5750 16
ElBurial Date Cemetery,Crematory or Facility Name
02/11/2021 Pine View Crematory
Entombment Address
ICremation Queensbury Town,New York
Donation
• �Removal Date Place Removed
and/or and/or Held
H(t1 Hold Address
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
. Remains are Shipped,If Other than Above
2 Address
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/11/2021 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:
Z
Date of Disposition 2 (l IT) Place of DispositionILI
(address)
W
CC
(section) (it:umber) ti. (grave number)
0 Name of Sexton or Person in Charge of emises
/please' r e +/�
Z iot/
W Signature Title 6th', g1�1�.
DOH-1555(07/18)p id 2
Public Health Law Sec. 4145(2b)
14531
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#