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Genier Sr., Anthony James 1,,41,„41 it 2i N EW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Anthony James Genier Sr. Male Date of Death Age If Veteran of U.S.Armed Forces, 02/19/2021 51 Years War or Dates 1.,. Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 79 Boulevard,Queensbury Town,New York 12804 a Manner of Death 1=1 Natural Cause ❑Accident El Homicide El Suicide ❑Undetermined ©Pending W U Circumstances Investigation W Medical Certifier Name Title C3 Connie Goedert Coroner Address 1400 St Route 9,Lake George Town,New York 12845 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 57 ❑Burial Date Cemetery,Crematory or Facility Name 02/25/2021 Pine View Crematory ElEntombment Address lCremation Queensbury Town,New York El Donation Z 0 Removal Date Place Removed and/or and/or Held F- Hold Address CO 0 4. Date Point of U) Li Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address El 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 j Remains are Shipped,If Other than Above Address Er W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/25/2021 Registrar of Vital Statistics Caroline Hildegarde 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: I- Z Date of Disposition 21 ZS Ill Place of Disposition EL ofr___ W (address) W U! CC (section) A (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises tt�Qs�rint �� (pi P W Title Ow/ow-roe Signature DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 1 ` Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#