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Upton, Gail Marie LF g1a NEW YORK STATE DEPARTMENT OF HEALTH ' — Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Gail Marie Upton Female Date of Death Age If Veteran of U.S.Armed Forces, 10/14/2021 69 Years War or Dates l . Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death © Natural Cause El Accident ❑Homicide El Suicide ❑Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title CI Asim Chaudry MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 453 ElBurial Date Cemetery,Crematory or Facility Name 10/16/2021 Pine View Crematory EiEntombment Address EiCremation . Queensbury Town,New York - El Donation • Removal Date Place Removed and/or and/or Held N Hold Address 0 d Date Point of Cl) ❑Transportation CT) by Common Shipment Carrier Destination 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 1— Remains are Shipped,If Other than Above Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/15/2021 Registrar of Vital Statistics W96ert Andrew Curtis(ECectronica[tySigned) (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: Z Date of Disposition Place of Disposition ul/►--- 2 (address) LU CC CC (section) ot number) c (grave number) • Name of Sexton or Person in Charge Premises Rif Z (please Tint) tL Signature Title `ezvrA DOH-1555{07/18)p 1 of 2 0 1,.t; Public Health Law Sec. 4145(2b) 4 Receipt '•\ • Human remains of i delivered on 20 ' Pine View Cemetery Representing the funeral home named s on,bigial,permit k` , 1- Official Funeral Directors Reg.or License# 1 1