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Ennis Jr., Gerald Alfred
79 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Gerald Alfred Ennis Jr. Male Date of Death Age If Veteran of U.S.Armed Forces, 09/18/2021 91 Years War or Dates 1948-50 Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital • Manner of Death © Natural Cause Accident Homicide ❑Suicide ❑Undetermined Pending W Circumstances Investigation W• Medical Certifier Name Title C1 Christopher Smith MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 406 111 Burial Date Cemetery,Crematory or Facility Name 09/20/2021 Pine View Crematory ❑Entombment Address Cremation Queensbury Town,New York Donation Z• Removal Date Place Removed and/or and/or Held Hold Address 0 G. Date Point of U) ❑Transportation p by Common Shipment Carrier Destination El 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 F— Remains are Shipped,If Other than Above Address W C' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/20/2021 Registrar of Vital Statistics `Rp6ert Andrew Curtis(E(ectronicallySigned) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F- t! W Date of Disposition lb7.°[4 Place of Disposition F,,�U` D--� JJaddress) W N (section) /�(lot number) C (grave number) aName of Sexton or Person in Charge of Premis s- �� LAai Z (plea e print) W Signature Title DOH-1555(o7/18)p 1 of 2 0 , bI 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#