Abbott, Barbara Ann 08/29/2021 23:10 5187477548 MBKILMER PAGE 01
II -DI
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Barbara Ann Abbott Female
Date of Death Age If Veteran of U.S.Armed Forces,
08/26/2021 77 Years War or Dates
Place of Death Hospital,Institution or
City,Town or Village Milton Town Street Address 479 Roland Street,Milton Town,New York 12020
pManner of Death II Natural Cause ❑Accident 0 Homicide 0 Suicide El Undetermined El Pending
W _ Circumstances Investigation
§ Medical Certifier Name Title
Charles Yun MD
Address
100 Park St,Glens Falls,New York 12801 _
Death Certificate Filed District Number Register Number
City,Town or Village Ballston Spa 4561 48
0 Burial Date Cemetery,Crematory or Facility Name
08/30/2021 Pine View Crematory
❑Entombment Address
EiCremation Queensbury Town, New York
nDonation
Z n Removaland/or Held
DateRemoved
and/or
Hold Address
NQ
a Date Point of
fp n Transportation Shipment
p by Common
Carrier Destination
Disinterment Dale Cemetery Address
i
Date Cemetery Address
❑Reinterment
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-South Glens Fells 01078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
t Remains are Shipped,If Other than Above
aAddress
W
o.
Permission is hereby granted to dispose of the human remains described above as Indicated.
Date Issued 08/30/2021 Registrar of Vital Statistics Brenda 5(owe(L(<ctronicalrySigned)
/signature)
District Number 4561 Place Ballston Spa, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: (( ,
ddress
Date of Disposition 41_1 l Ili Place of Disposition /at7,.l(--- Li`1
ILI
g (section) /Or number) (grave number)
SName of Sexton or Person in Charge of Pr ises ' /' 1 h''' `.. S
/ (pies
W fli26111(It
Signature z
6!! 1t1 Title
DOH-1555(oi/18)p a of 2
Public Health Law Sec. 4145(2b)
1
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#