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Harwood, Carol Vivian ' 7,3 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Carol Vivian Harwood Female Date of Death Age If Veteran of U.S.Armed Forces, 02/23/2021 68 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Greenwich Town Street Address 830 Rte 49,Greenwich Town,New York 12809 `p Manner of Death ©Natural Cause Accident Homicide 111 Suicide ❑Undetermined Pending U Circumstances Investigation W Medical Certifier Name Title O Rita All NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Greenwich 5757 5 0 Burial Date Cemetery,Crematory or Facility Name 02/26/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York 0 Donation z Removal Date Place Removed - and/or and/or Held H- Hold Address 0 d Date Point of V) ❑Transportation 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-Argyle 01077 Address 123 Main St,Argyle,New York 12809 Name of Funeral Firm Making Disposition or to Whom -. Remains are Shipped,If Other than Above 5 Address CC W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/26/2021 Registrar of Vital Statistics Kimberly Whelan(ECectronicafTy Signed) (signature) District Number 5757 Place Greenwich, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: l— WDate of Disposition a-R 7" 02,1 Place of Disposition 1); f;e) r,J£ ( C ry ti•h s.{ 2 laddtryll W N (section) (lot number) (grave number) 114401 Name of Sexton or Person in Charge of Premise �A�1j1c> �� (please print) Z W Signature Title ofv-•l,'� DOH-1555(07/18)p t of 2 r • Public Health Law Sec. 4145(2b) Receipt Human remains of .'.t ` delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# t '