Criss,Martha Ann f
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k
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Martha Ann Criss Female
Date of Death Age If Veteran of U.S.Armed Forces,
06/26/2021 91 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare
W
p Manner of Death ❑X Natural Cause Accident Homicide ❑Suicide ❑Undetermined Pending
U Circumstances Investigation
W Medical Certifier Name Title
CI Leonard Gelman MD
Address
4573 State Route 40,Argyle Town,New York 12809
Death Certificate Filed District Number Register Number
City,Town or Village Argyle 5750 44
❑Burial Date Cemetery,Crematory or Facility Name
06/28/2021 Pine View Crematory
Entombment Address
0 Cremation Queensbury Town,New York
❑Donation
Z Removal Date Place Removed
and/or and/or Held
Hold Address
O
CL Date Point of
t/) j Transportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
0 Disinterment
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
Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/28/2021 Registrar of Vital Statistics ShelleyMckernonglectronicalC Signer9
(signature)
District Number 5750 Place Argyle, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F— / Z.�
W Date of Disposition V' 'ti' Place of Disposition g.t.11-- 4,
2 (address)
lL
CC 0 (section) d(lot,number) (grave number)
▪ Name of Sexton or Person in Charge of Premis
(plea print) /' ,/�
IL Signature Title
(t �'`
DOH-1555(07/18)p'of 2
Public Health Law Sec. 4145(2b) 0 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# '