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Carpenter, Laura Anne It. 4t- Ego NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Laura Anne Carpenter Female Date of Death Age If Veteran of U.S.Armed Forces, 08/16/2021 64 Years War or Dates f.: Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address Glens Falls Center for Rehabilitation and Nursing CManner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation WMedical Certifier Name Title Wendy Steinhacker PA Address 152 Sherman Ave,Queensbury Town,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 170 ❑Burial Date Cemetery,Crematory or Facility Name 08/16/2021 Pine View Crematory ❑Entombment Address ▪Cremation Queensbury Town,New York ❑Donation Z• El Removal Date Place Removed and/or and/or Held F. Hold Address 0 a Date Point of Cl) ❑Transportation Shipment ES by Common — Carrier Destination ❑Disinterment Date Cemetery Address Date Cemetery Address ❑Reinterment 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 5 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/16/2021 Registrar of Vital Statistics Caroline JfiCcfegardTe Barber(ECectronicaltySigned) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: r' W Date of Disposition $((1(ZI Place of Disposition 2 (address) W CC CC (section) /Z(lot number) (grave number) t1 O Name of Sexton or Person in Charge of mises �` � Z (plea print) .,�,( W Signature Title C4{"'` DOH-1555(07/18)p 1 of 2 1 015046 Public Health Law Sec. 4145(2b) 1 Receipt 1 , Human remains of ', , 'i. ''s ,..._‘ ', i ' -It . ., , delivered on k. i , 20 ,. i. , s Pine View Cemetery Representing the funeral hoinenamedi on burial permit Official Funeral Directors Reg. or License# ILI ,'C-ii4