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Davis, Mildred, Beetman 0 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Mildred Beetman Davis Female Date of Death Age If Veteran of U.S.Armed Forces, 06/05/2021 99 Years War or Dates F— Place of Death Hospital,Institution or Z City,Town or Village Cambridge Town Street Address 31 Hopkins Lane,Cambridge Town,New York 12816 UJ p Manner of Death © Natural Cause Accident ❑Homicide 0 Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title © Ashley Watson NP Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Cambridge 5751 3 EBurial Date Cemetery,Crematory or Facility Name 06/08/2021 Pine View Crematory Entombment Address 0 Cremation Queensbury Town,New York ❑Donation O• CIRemoval Date Place Removed and/or and/or Held N Hold Address 0 Date Point of N ❑Transportation p by Common Shipment 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-Argyle 01077 Address 123 Main St,Argyle,New York 12809 Name of Funeral Firm Making Disposition or to Whom F Remains are Shipped,If Other than Above 2 Address CC LU 0- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/08/2021 Registrar of Vital Statistics Heather Greenawalt(Electronically Signed) (signature) District Number 5751 Place Cambridge, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F— � Z Date of Disposition iv(id 1 I Place of Disposition '6 ` f=` 2 (address) LU CO CC (section) (lot number) (grave number) GName of Sexton or Person in Charge of Pr ises ���t Z (plea e print) W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) U -4 8 4 7 Receipt Human remains of " i- ' ` i delivered on , 211.. Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# /` , ' " ,;