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Grabowski, Loretta Anna .sue f w 11 t i c NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Loretta Anna Grabowski Female Date of Death Age If Veteran of U.S.Armed Forces, 07/28/2021 89 Years War or Dates 1 Place of Death Hospital,Institution or W City,Town or Village Saratoga Springs Street Address Saratoga Hospital p Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title O Stephen Offord MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 408 ❑Burial Date Cemetery,Crematory or Facility Name 08/01/2021 Pine View Crematory ❑Entombment Address O Cremation Queensbury Town,New York ❑Donation ❑Removal Date Place Removed O and/or Held H and/or - Hold Address 0 d Date Point of U) ❑Transportation Shipment Q by Common Carrier Destination El 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 2 Address C w a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/30/2021 Registrar of Vital Statistics Jo/In Pau(Franc (E(ectronica1Ty Signed) (signature) District Number 4501 Place Saratoga Springs, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I z Date of Disposition $/2 III Place of Disposition ?cutlet.— 4O(1... 2 (address) W NCC (section) rftot rurmber) (grave number) cName of Sexton or Person in Charge of Premises r"' ` 'itnel d z (please rint) W Title l M(CV< Signature e DOH-1555(07/18)p 1 of 2 Auk- Public Health Law Sec. 4145(2b) )14 Receipt Human remains of J.,/ delivered on , 20/ Pine View Cemetery Repre/ senting the funeral home named on burial permit Official Funeral Directors Reg.or License# it// (/