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Rumble, Kay Mary I -72 NEW YORK STATE DEPARTMENT OF HEALTH ' Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kay Mary Rumble Female Date of Death Age If Veteran of U.S.Armed Forces, 02/11/2021 85 Years War or Dates H Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ©Natural Cause 0 Accident El Homicide El Suicide El Undetermined El Pending W Circumstances Investigation WMedical Certifier Name Title CI Shahid Ahmed MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 96 EiBurial Date Cemetery,Crematory or Facility Name 02/12/2021 Pine View Crematorium ❑Entombment Address IDCremation Queensbury Hamlet,New York Donation Removal Date Place Removed and/or and/or Held H Hold Address N 0 G. Date Point of U) ❑Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom F- Remains are Shipped,If Other than Above a Address CC W EL Permission is hereby granted to dispose of the human remains described above as indicated. .0), Date Issued 02/12/2021 Registrar of Vital Statistics `R9bertAndrew Curtis(EfectronicalrySigned) (signature) $R. 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: S W Date of Disposition ;�-%3-a�4 i Place of Disposition �;` rJ C'_ vA:fz� e j fh'l 2/�'�` 2 (address) W /section) (lot number) (grave number) SName of Sexton or Person in Cha a of Pre is d i"in v ci r- !ibDCi z c (please print) LLISignature' i� l Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 3 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on.:burial^permit Official Funeral Directors Reg.or License#