Fuller, Veronica Ruth NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Veronica Ruth Fuller Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/21/2021 77 Years War or Dates
F.. Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address Glens Falls Center for Rehabilitation and Nursing
ILI
p Manner of Death Natural Cause I=1 Accident Homicide Suicide ❑Undetermined ❑Pending
Circumstances Investigation
U
W Medical Certifier Name Title
CI Elizabeth Bessette NP
Address
152 Sherman Ave,Queensbury Town,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 112
0 Burial Date Cemetery,Crematory or Facility Name
05/24/2021 Pine View Crematory
❑Entombment Address
ICremation Queensbury Town,New York
❑Donation
is Removal Date Place Removed
and/or and/or Held
Hold Address
N
O
d Date Point of
Cl) Li Transportation Shipment
p by Common
Carrier Destination
El 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
2 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/24/2021 Registrar of Vital Statistics Caroline J(ilcfegarde Barber(ECectronically Signed)
(signature)
District Number 5657 Place Queensbury, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
l--
Z Date of Disposition 5—Z..-')2./ Place of Disposition hry)iat, G/ iiA�v
2 (address/
W
CC CC (section) (lot number) (grave number)
1 _ � f
Name of Sexton or Person in Charge of Premises J�,1 c" �4_Vfr1Rw'G
(please print)
Z /
W Signature Title L/P.r+a O e//ii,/E!
DOH-1555(07/18)p 1 of 2
V 411.
Public Health Law Sec. 4145(2b) 014 812
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#