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Flores-Knowlton, Kristina Ann NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kristina Ann Flores-Knowlton Female Date of Death Age If Veteran of U.S.Armed Forces, 07/11/2021 43 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Granville Town Street Address 1792 County 23 Route, Granville Town, New York 12832 p Manner of Death 0 Natural Cause ❑Accident 1=1 Homicide ['Suicide ElUndetermined ©Pending Circumstances Investigation W Medical Certifier Name Title C Wesley Perry Coroner Address 415 Lower Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed District Number Register Number City,Town or Village Granville 5756 57 Burial Date Cemetery,Crematory or Facility Name 07/14/2021 Pine View Crematory Entombment Address X❑Cremation Queensbury Town,New York 0 Donation Z Removal Date Place Removed and/or and/or Held F. N Hold Address 0 Date Point of U)❑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-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom H- Remains are Shipped,If Other than Above 1 Address CC W C' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/13/2021 Registrar of Vital Statistics jenny Linda Ivf Martelte(Ehctronica1ty Signed) (signature) District Number 5756 Place Granville, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W 1 Date of Disposition 1IS I Zi Place of Disposition 7 A1L 2 (address) W CC CC (section) tot number) (grave number) Name of Sexton or Person in Charge Premises ` 'l+ L--�"`"'V� 111 Charge Premises /%� (ptea4e print) Signature 7.); �i�— Title tIW r DOH-1555(07/18)p i of 2 Public Health Law Sec. 4145(2b) 014943 Receipt Human remains of delivered on , 20 r Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#