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Burt, Chris Edward
NEW YORKSTATE DEPARTMENT OF HEALTH • _ Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Chris Edward Burt Male Date of Death Age If Veteran of U.S.Armed Forces, 07/09/2021 57 Years War or Dates 1982-1983 H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital ILI p Manner of Death © Natural Cause u Accident 0 Homicide ❑Suicide 0 Undetermined 1:1Pending W Circumstances Investigation W Medical Certifier Name Title 0 Abigail Macomber PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 280 ❑Burial Date Cemetery,Crematory or Facility Name 07/12/2021 Pine View Crematory 0 Entombment Address 0 Cremation Queensbury Town,New York ❑Donation ZRemoval Date Place Removed and/or and/or Held H( Hold Address an 0 a Date Point of U) ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment 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 E— Remains are Shipped,If Other than Above * Address CC W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/09/2021 Registrar of Vital Statistics Rpbert Andrew Curtis(E(ectronica((y 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~ IL Date of Disposition 7 13 I t,� Place of Disposition . �,}�n,z,., 2 (address) W CC CC (section) (lot number) (grave number) 0 AName of Sexton or Person in Charge of Pr i s ( Z (p a si1t�u—.•S CAI e print) W Signature 1'" Title C v'" it DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 1 49 35 Receipt ... . _ ., , Human remains of . A k -1--- delivered on ' -' - i , 20 . - , Pine View Cemetery Representing the funetial home named on burial permit Official Funeral Directors Reg.or License#