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Jones, Jennie Lee
4 3c_3 NEW YORKSTATE DEPARTMENT OF HEALTH - Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Jennie Lee Jones Female Date of Death Age If Veteran cp.S.Armed Forces, 04/13/2021 91 Years War or Dies • Place of Death Hospital,Institution or W City,Town or Village Granville Town Street Address Slate Valley Center for Rehabilitation and Nursing p Manner of Death ©Natural Cause ❑Accident ElHomicide ❑Suicide ❑Undetermined ❑Pending 111 U Circumstances Investigation LU Medical Certifier Name Title 0 Leonard Gelman MD Address 10421 State Route 40,Granville Town,New York 12832 Death Certificate Filed District Number Register Number City,Town or Village Granville 5756 37 ❑Burial Date Cemetery,Crematory or Facility Name 04/16/2021 Pine View Crematory ❑Entombment Address Cremation Queensbury Town,New York ❑Donation 0 ❑Removal Date Place Removed and/or and/or Held - Hold Address 0 . 1-1 Date Point of U) ❑Transportation p 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 f- Remains are Shipped,If Other than Above 2 Address CC W a- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/15/2021 Registrar of Vital Statistics jenny Linea 911 Martelle(6Cectronica1ty Signed) (signature) District Number 5756 Place Granville, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IH J� W Date of Disposition 7-/7-24,A/ Place of Disposition 1);`,.,;e (address)--) Cn CC (section) ,/ (lot number) (grave number) 0` Name of Sexton or Person in Charge o Premises A1�HID D E=- (Dcx>d (please print) IW Signatures---- :7_o•gp Title D ✓Qi'ri 1---- DOH-1555(07/18)p 1 of 2 40 Public Health Law Sec. 4145(2b) t 1.d 7'7 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#