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Urbonowicz, Joshua Joseph (4,14 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Joshua Joseph Urbonowicz Male Date of Death Age If Veteran of U.S.Armed Forces, 08/08/2021 40 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Corinth Town Street Address 48 Comstock Road,Corinth Town, New York 12833 `p Manner of Death ❑ Natural Cause ElAccident ❑Homicide ©Suicide ❑Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title Q David DeCelle Coroner Address 40 McMaster Street,Ballston Spa,New York 12020 Death Certificate Filed District Number Register Number City,Town or Village Corinth 4553 ❑Burial Date Cemetery,Crematory or Facility Name 08/11/2021 Pine View Crematory ❑Entombment Address ElCremation Queensbury Town,New York ❑Donation El Removal Date Place Removed O and/or Held rand/or N Hold Address O a. Date Point of Cl) ❑Transportation Shipment p by Common 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 Remains are Shipped,If Other than Above S Address CC W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/10/2021 Registrar of Vital Statistics 'Brenda L'Pens(cECectronicalTy Signed) (signature) District Number 4553 Place Corinth, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ~ �«..� WDate of Disposition 8(12,('t.� Place of Disposition 2 (address) W (section) /f/ (lot number) (grave number) L Name of Sexton or Person in Charge of remises Z (pie se print) lL Signature Title ��`���� DOH-1555(07/18)p i of 2 ��. 0 A... F'029 ¢ P Public Health Law Sec. 4145(2b) Receipt Human remains of c delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# 1