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Fuller, Collin Patrick a , Jt NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Collin Patrick Fuller Male Date of Death Age If Veteran of U.S.Armed Forces, 05/15/2021 50 Years War or Dates 1988-1992 E... Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W Manner of Death © W Natural Cause El Accident0 Homicide 0 Suicide Undetermined Pending V Circumstances Investigation GMedical Certifier Name Title William Cleaver MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 215 ❑Burial Date Cemetery,Crematory or Facility Name 05/17/2021 Pine View Crematory El Entombment Address 0 Cremation Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held H 6- Hold Address 0 0. Date Point of co Li 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-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom F- Remains are Shipped,If Other than Above 5 Address OC IL! IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/17/2021 Registrar of Vital Statistics Robert Andrew Curtis(Electronically 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: W~ L 4-c—, Date of Disposition S(l$) "Z, Place of Disposition ti, 2 (a ress) W IA CC (section) 4 (tot number) (grave number) O Name of Sexton or Person in Charge of p�mises t 1 r�' L h4A (pie4se print w Signature Title (poll-TO/4 DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#