Powers, Lauren Elizabeth - � s9
NEW YORK STATE DEPARTMENT OF HEALTH
Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Lauren Elizabeth Powers Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/05/2021 24 Years War or Dates
F Place of Death Hospital,Institution or
2 City,Town or Village Cohoes Street Address 180 Columbia Street,Cohoes,New York 12047
W Manner of Death Undetermined Pending
W Natural Cause ❑Accident ❑Homicide Suicide ❑
Circumstances Investigation
W Medical Certifier Name Title
Antonio Sturges Coroner
Address
175 Green Street,Albany,New York 12202
Death Certificate Filed District Number Register Number
City,Town or Village Cohoes 0102 112
❑Burial Date Cemetery,Crematory or Facility Name
09/09/2021 Pine View Crematory
❑Entombment Address
X❑Cremation Queensbury Town,New York
ElDonation
Removal Date Place Removed
and/or and/or Held
H Hold Address
0
tai) ❑Transportation Date Point of
CI 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-South Glens Falls 01078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
}_ Remains are Shipped,If Other than Above
2 Address
C
W
C' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/08/2021 Registrar of Vital Statistics Lori Ann Tondo(ECectronicalTy Signed)
(signature)
District Number 0102 Place Cohoes, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition q g(7( Place of Disposition ,�c��� d^�
(address)
W
N (section) �7 (lot n r) (grave number)
Q � lry
el Name of Sexton or Person in Charge of Premises ^' L
(please print)
W Signature C / Title 60.0e
DOH-1555(018)p t of 2
1 - 0 1 5 1'"
i Public Health Law Sec. 4145(2b)
I
1
iReceipt ... ,
I . A
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i t '
Human remains of ; , , 20
delivered on ' ,
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j Pine View Cemetery Representing the funeral home named op pgial permit
i Official Funeral Directors Reg.or License#
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