Loading...
Grant, Jean Marie . ,014 a --xt NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Jean Marie Grant Female Date of Death Age If Veteran of U.S.Armed Forces, 09/09/2021 90 Years War or Dates F. Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death © Natural Cause E Accident ❑Homicide 0 Suicide E Undetermined 0 Pending Circumstances Investigation W Medical Certifier Name Title CI Marvin Davidowitz MD Address 100 Park St,Glens Falls, New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 393 11 Burial Date Cemetery,Crematory or Facility Name 09/10/2021 Pine View Crematory Entombment Address 0 Cremation Queensbury Town,New York ElDonation Date Place Removed 0 Removal and/or Held I- and/or N Hold Address 0 Date Point of tl) L j Transportation Shipment p by Common 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 H Remains are Shipped,If Other than Above 2 Address IC W a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/10/2021 Registrar of Vital Statistics &ben Andrew Curtis(ECectronicaliy Signed) (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: H 4 Z Date of Disposition 9��ZOZ/ Place of Disposition R 4(2.. ���0 C'i^!� 4, W (address) I!(CC rave number/ CO (section) (lot number) lg o Name of Sexton or Person in Charge of Premi 1\ Mo �a� Zfplease print) IW Signature 4 .:/'lf Title 0ft1 R. r" DOH-1555(07/i8)p 1 of 2 0 1 5130 Public Health Law Sec. 4145(2b) Receipt • t / z.,•1 Human remains of • s '1' delivered on , 20 , r / Pine View Cemetery Representing the funeral home named ppei‘nliAt permit Official Funeral Directors Reg.or License# L