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Trumpower, Janis Maria NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Per it Bureau of Vital Records Name First Middle Last Sex Janis Maria Trumpower Female Date of Death Age If Veteran of U.S.Armed Forces, 02/19/2021 71 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation p Manner of Death © Natural Cause Accident Homicide Suicide Undetermined Pending 0 Circumstances Investigation Q Medical Certifier Name Title Kenneth France MD Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 108 Burial Date Cemetery,Crematory or Facility Name 02/23/2021 Pine View Crematory ❑Entombment Address Cremation Queensbury Town,New York LiDonation O Removal Date Place Removed and/or and/or Held N Hold Address O.0 U) Transportation Date Point of 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-Fort Edward 01079 Address 82 Broadway,Fort Edward, New York 12828 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above a Address CC W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/23/2021 Registrar of Vital Statistics R96ertAndrew Curtis(E(ectronicatTy Signed) (signature) District Number 5601 Place Glens Falls, 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('I312' Place of Disposition 2 (address) (section)CC (!ot number) (grave number) O Name of Sexton or Person in Charge of Pre ' es �N+ L ZNvtr Z (pllease print/ tU Signature Title ��`""� DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 014574 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#