Delk, Audrey Barbara _ scc
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Audrey Barbara Delk Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/01/2021 82 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 xiNatural Cause 1=1 Accident 1=1 Homicide ❑Suicide ❑Undetermined ❑Pending
U Circumstances Investigation
W Medical Certifier Name Title
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 46
▪Burial Date Cemetery,Crematory or Facility Name
07/06/2021 Pine View Crematory
❑Entombment Address
®Cremation Queensbury Town,New York
❑Donation
O Removal Date Place Removed
and/or and/or Held
H N Hold Address
0
a. Date Point of
f� �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
g Address
Q
W
0-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/06/2021 Registrar of Vital Statistics Shelley Mckernon(Electronically Signed)
(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:
ZW Date of Disposition '�h t1 Place of Disposition
2 (address)
W
(section)
of number) (grave number)
tt
0 Name of Sexton or Person in Charge of P ises Pis ��
(please int)
W 1911,
Signature Title l� h
DOH-1555(07/18)p 1 of 2
6
Public Health Law Sec. 4145(2b) )1 4 9 1,i
Receipt
Human remains of . delivered on , 20
_a=
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#