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Mallison, Karen Marie N EW YORK STATE DEPARTMENT OF HEALTH LF Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Karen Marie Mallison Female Date of Death Age If Veteran of U.S.Armed Forces, 08/16/2021 79 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare pManner of Death © Natural Cause ❑Accident Homicide ID Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title CI Leonard Gelman MD Address 4573 State Route 40,Argyle Town,New York 12809 Death Certificate Filed District Numb Register Number City,Town or Village Argyle 5750 53 ▪Burial Date Cemetery,Crematory or Facility Nr .e 08/19/2021 Pine View Crematory Entombment Address ElCremation Queensbury Town,New York ▪Donation ZO 0 Removal Date Place Removed and/or and/or Held - Hold Address N 0 O. Date Point of N ❑Transportation Shipment Q 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-Argyle 01077 Address 123 Main St,Argyle,New York 12809 Name of Funeral Firm Making Disposition or to Whom F. Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/17/2021 Registrar of Vital Statistics Shelley Mckernon(Electronically Signed) (signature) District Number 5750 Place Argyle, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Il— W Date of Disposition g)Zp(T �C i4 Place of Disposition JL c I (address) W NCC (section) (lot number) (grave number) 0 Name of Sexton or Person in Char of Premises �" pease print) �p W Title Signature DOH-1555(07/18)p 1 of 2 0 .:y,516 Public Jealth 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#