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Jennings, Marjory Irene f 4 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Marjory Irene Jennings Female Date of Death Age If Veteran of U.S.Armed Forces, 07/24/2021 93 Years War or Dates ▪ Place of Death Hospital,Institution or W City,Town or Village Wilton Town Street Address 60 Waller Road 216,Wilton Town, New York 12831 p Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title Cl Madison Zuis NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Gansevoort 4569 35 ❑Burial Date Cemetery,Crematory or Facility Name 07/27/2021 Pine View Crematory ❑Entombment Address Cremation Queensbury Town,New York ❑Donation 0Z ❑Removal Date Place Removed and/or and/or Held H Hold Address 0 CL Date Point of U) ❑Transportation 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 • 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 07/26/2021 Registrar of Vital Statistics Susan Baldwin(E(ectronica((ySigned) (signature) District Number 4569 Place Gansevoort, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 1- W Date of Disposition —I?—;.l Place of Disposition pt n v V>GW C ra, kcY 2 (address) W CA CC (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises Ttf m by StVS�<•S (please print) lu Signature #) " Title CI'k,rigtcr DOH-1555(07/18)p t of 2 1 1 1 Public Health Law Sec. 4145(2b)� 9 m4 ' 6 i IReceipt 1 1 1 Human remains of delivered on , 20 1 Pine View Cemetery Representing the funeral home named on burial permit 1 Official Funeral Directors Reg.or License# I i