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Armstrong, Ronald Earl g3$ NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Ronald Earl Armstrong Male Date of Death Age If Veteran of U.S.Armed Forces, 10/02/2021 83 Years War or Dates 1956-60 Place of Death Hospital,Institution or Z City,Town or Village Moreau Town Street Address Home of the Good Shepard W Manner of Death © Natural Cause 0 Accident El Homicide Suicide ❑Undetermined ID Pending W Circumstances Investigation W Medical Certifier Name Title Darci Gaiotti-Grubbs MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Moreau 4562 47 Burial Date Cemetery,Crematory or Facility Name 10/05/2021 Pine View Crematory ElEntombment Address 0 Cremation Queensbury Town,New York ❑Donation Date Place Removed Removal and/or Held H and/or Hold Address 0 Date Point of U) Li Transportation Shipment ▪ by Common Carrier Destination 11 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 H Remains are Shipped,If Other than Above 5 Address CC W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/05/2021 Registrar of Vital Statistics Leeann Mc cabe(Electronically Signed) (signature) District Number 4562 Place Moreau, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IH Z Date of Disposition lot 1p IV Place of Disposition �� W (address) Illl CO CC (section) (lot number/ (grave number) Name of Sexton or Person in Charg of Premises A�' � atse print) W Signature Title ` DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 5205 Receipt Human remains of �� delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#