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Linendol Jr., Edmond L.
l(9g NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Edmond L.Linendoll Jr. Male Date of Death Age If Veteran of U.S.Armed Forces, 02/09/2021 87 Years War or Dates (— Place of Death Hospital,Institution or Z City,Town or Village Moreau Town Street Address 16 East Road,Moreau Town,New York 12803 UJ p Manner of Death © Natural Cause ❑Accident ❑Homicide 1=1 Suicide Undetermined El Pending W Circumstances Investigation U G Medical Certifier Name Title Michael Adams MD Address 1448 Route 9,Fort Edward Town,New York 12828 Death Certificate Filed District Number Register Number City,Town or Village Moreau 4562 11 Burial Date Cemetery,Crematory or Facility Name 02/10/2021 Pine View Crematory ❑Entombment Address lCremation Queensbury Town,New York Donation Z ❑Removal Date Place Removed and/or and/or Held ~ Hold Address tti 0 D. Date Point of Cl) ❑Transportation Shipment O 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-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above "2 Address CC W CL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/10/2021 Registrar of Vital Statistics Leeann Mc cabe(Electronically Signed) (signature) District Number 4562 Place Moreau, 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 Z/It I Z( Place of Disposition / W (address) W (section) (1 number) (grave number) �11 \ .) O Name of Sexton or Person in Charge of Premises 1 PH nr�`�� Z (please riot) �^ y_ t!V Signature Title ( f ,iX�- DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) 1 a Receipt Human remains of ` �' delivered on , 20 /r Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#