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Russo, Lillian Joann 74 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Lillian Joann Russo Female Date of Death Age If Veteran of U.S.Armed Forces, 08/24/2021 88 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Town Street Address Fort Hudson Nursing Center Inc W• Manner of Death Pending © Natural Cause �Accident �Homicide �Suicide �Undetermined � U Circumstances Investigation W Medical Certifier Name Title O Carrie Miron PA Address 319 Broadway,Fort Edward Town,New York 12828 Death Certificate Filed District Number Register Number City,Town or Village Fort Edward 5755 49 Burial Date Cemetery,Crematory or Facility Name 08/26/2021 Pine View Crematory ❑Entombment Address 0 Cremation Queensbury Town,New York ❑Donation • ElRemoval Date Place Removed and/or and/or Held — Hold Address 0 C. Date Point of (A ❑Transportation by Common Shipment Carrier Destination El Disinterment Date Cemetery Address Date Cemetery Address Reinterment 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 l` Remains are Shipped,If Other than Above 2 Address fr W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/26/2021 Registrar of Vital Statistics Aimee L Mahoney(Electronically Signed) (signature) District Number 5755 Place Fort Edward, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition g'�7"J—j Place of Disposition p5v,,, }�;t�W Cfe441 W (address) w CC (section) (lot number) (grave number) g Name of Sexton or Person in Charge of Premises Tc. 1{ iy `Qt Cc,S (please print) W Signature Title (.(e mc,4G� DOH-1555(o7/t8)p t of 2 Public Health Law Sec. 4145(2b) ".` Receipt Human remains of delivered on , 20 • Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#