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Kennedy, Dawn Anita 30k) NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Dawn Anita Kennedy Female Date of Death Age If Veteran of U.S.Armed Forces, 03/25/2021 87 Years War or Dates f,. Place of Death Hospital,Institution or lZ City,Town or Village Queensbury Town Street Address Glens Falls Center for Rehabilitation and Nursing W Manner of Death ©Natural Cause ❑Accident El Homicide ❑Suicide ❑Undetermined Pending Circumstances Investigation W Medical Certifier Name Title Wendy Steinhacker PA Address 152 Sherman Ave,Queensbury Town,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 78 Burial Date Cemetery,Crematory or Facility Name 03/26/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York Donation Z CI Removal Date Place Removed and/or and/or Held Hold Address O Q. Date Point of U) ❑Transportation p by Common Shipment Carrier Destination Ei 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 — Remains are Shipped,If Other than Above 5 Address CC W 0- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/26/2021 Registrar of Vital Statistics Caroline xCiegardf Barder(ECectronicalTySigned) (signature) District Number 5657 Place Queensbury, New York I certify that the remains o,�f the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition Place of Disposition e 2 (address)---"' W CC (section) (lot number) (grave number) 0 .of Sexton or Person in Charge Premises /1 �W����"t W pa ,/ (please print/ W Signature l /" Title CreS`z DOH-1555(07/18)pi of 2 Public Health Law Sec. 4145(2b) 014;:7 2 Receipt Human remains of t ' d` ('; t delivered on , 20 /- Pine View Cemetery Representing the funeral home name4 o 1 rial permit Official Funeral Directors Reg.or License# 1111, �f/